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DATF '1 ` �V U SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 0 k 2016 ENVIRONMENTAL HEALTH DEPARTMENT -7 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 91 <br /> PER PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: rn VUPi BUSINESS/AGENCY: e6h n ito ri EP q),neem. "(e. <br /> ADDRESS; 415M N Vwawlem M. SEE lo?) CITY/STATE/ZIP: Fy-eSnD, Cft 3�22 <br /> PHONE (1):(95 0,7(v q✓l 9cF.�I PHONE (2):(r 271D'Q3y�►�OR E-MAIL: �V@teohnica,W <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) 1 I A�6v E]CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) 1oO I/O `�• 1 • "I '""' `�" �'J (, 110/1�, I �'T •Ai <br /> El HAZARDOUS WASTE ,YV ,11,t r n�'�► J l/� (1 DAIRY1-tt, <br /> TIERED PERMITTED FACILITY 2 ❑ <br /> ABOVEGROUND TANK <br /> %UST (MONITORING/REMOVAL) ❑PWs <br /> ❑HAZARDOUS MATERIALS 3 <br /> RSPILURELEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY <br /> POOL/SPA ❑SITE MITIGATION <br /> DAIRY 5 + —10 <br /> 1W N <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ 6 E]HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING <br /> ❑SOLID WASTE <br /> WASTE TIRE 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. staff Name: ( {j <br /> EHD 48-06 <br />