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■EM Frotn:5103383192 09/07/2017 12:51 #S76 P.001/001 <br /> � <br /> ,E■ RECEIVED EHD LOG NUMBER <br /> DATE RECEIVEDQVyj SAN JOAQUIN COUNTY <br /> SEP 0 7 20V 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 f=ast Hazelton Avenue, Stockton, CA 95205-6232 <br /> 0EWp4ofAMEWAL HeAM Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehd <br /> PEMMIMER11ylGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1' e,"c-f He-v%k,i BUSINESSIAGENCY: <br /> ADDRESS: �2o 3rd Sit CITYISTATEIZIP: C A- 0 <br /> PHONE (1): -S2 - Z o�q PHONE(2): Iv ` 'f D - 31 qr FAX OR E-MAIL: hlLniCAi 0,AeiCpAsi.,14Af S -Gor <br /> Please allow 10 business days from date of application submittal for the records to tae available. FAoc : Slo-33g- 311 <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 q f 7// -?-- <br /> 1_ List up to ten addresses in space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es)- At least one file a MUST be selected. Fax to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be acceptefi.Applications received after 3:00 prn will be processed the next business day. <br /> Z For assistance in identifying the nature and content of EHD records,please contact END 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 flies 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, f t1� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5!00PM (EXCLUDING HOLIDAYS) <br /> Electronic information: List 7 Map—Description: <br /> Specific Date flange of Information Requested: From o s to c I,'+rY t'y" <br /> ENVIRONMENTAL_ <br /> HEALTH DEPARTMENT FILE ADDRESS L <br /> FILES EHD�p USE ONLY <br /> ) <br /> lzl�UNOERGROUND TANK(UST) Stre9t# Street Name City ,>- <br /> 13d COISUI.IER <br /> CLEANUP 587E ILOP) ���� P <br /> OTHER CLEANUP SITE(NON-LOP) Y` f�` L G 1� f� <br /> HAZARDOUS WASTE <br /> KTIERED PERMITTED FACILITY <br /> 54 ABOVEGROUND TANK [ l `l { 4 1V`� <br /> 5PST (MONITORING I REMOVAL) PWS <br /> HAZARDOUS MATERIALS N �• �,�- • a �Y Q <br /> �SP:LLIRELEASE RESPONSE U <br /> WATER QUALITYff SCLID WASTE FACILITY I VEHICLE <br /> (rFom FACILITY <br /> rye' <br /> POOL f SPA ///sss "" ITE MnISAT'ON <br /> �J6/ ( �1 /' gl�/1 yl} .,�},� <br /> DAIRY V�J l,✓(J iI�r�t' �yi <br /> LAND USE APPLICATION SITES 5T� - }` <br /> l SEPTIC PUMPER TRUCK _ (ce'L I <br /> 'a'e �CtGj -if� '�f'C, • <br /> ! a vI,,Cl t -r PP oU51NG <br /> "`1 <br /> YARD I CHEMICAL TOILETS 600 <br /> l�WASTEWATER TREATMENT PLANT ^ CU?A <br /> HOUSING ABATEMENT y i^, f'1, L1� � /-. R ,..�„ `n 4*1-k1✓ <br /> MOTEIJHOTEL /� /� ly�F <br /> I�f I CWCKEN RANCH I DOG KENNEL i 1 i CAIN L�A, ke/ � f f�J�&P �%� j CVPA�-DIST <br /> MEDICAL WASTE FACILfTY 8 <fL. CAIN '�i. 1 „r f (� <br /> TATTOO/BODY PIERCING - <br /> c llUtrlfS (5pt[ls CcLrfs i3 t !!lG41 �(� c Y ouowASE <br /> WASTE TIRE <br /> �COMPLAI NT ^' Cyt fI <br /> OTHER(PLEASE SPECIFY): 1s4� iJ Ac�'OUWTwo <br /> 10 <br /> •"'6PXED AREA•EHD t1SE ONLY"' <br /> +1'('1 - 'A z -ry", reLe--. off- V^4 cti WA <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br /> EHD 4"6 <br /> Received Time Sega, T 2017 12AVM N3, 2245 <br />