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RECEIVED <br /> SAN ,.J Q A Q U I N DEC 5 2017 Environmental Health Department <br /> C0 U N TY PYBLIC RECORDS RELEASE APPLICATION <br /> ENVIRONMENTAL HEALTH � �376jl <br /> PERMITISERWES IFF EHD LOG NUMBER: <br /> APPLICANT: _ '• AKa '~jc-o,� BUSINESSIAGENCY:C PT C.ok15UL.rA IJ-n <br /> ADDRESS. 90(,(, C �i a1 � t ,1 ray 5u��;� Ii o cmnsra,TErzl�: C_1��2Y�NG )7s) <br /> PHONE(1): r'ilc� �a 27o'7 PHONE(2): FAX OR E-MAIL:'5g�y�,or,,=t2&C-_Cc2JS L:1rANri,6�M <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac oto arra ge n appo ntment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT J� DATE �� / � 1 Qui �� <br /> 1. List up to ten addresses i e space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the ppropriate bQX(es). At least one file type MUST be selected. Fax to{2091464-0138,mail to the <br /> address Indicated below,or small to Info@-sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted below. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately telt(10) <br /> days after receipt of application. The files will be held far 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 Eula staff at the expense of the applicant. <br /> Future file revlews by the same applicant may require a$152 deposit prior to review. + <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) `� l <br /> Electronic Information: a List❑ Map—Description: <br /> Specific Date Range of Information Requested; From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( Y 9 accepted) EHD USE ONLY <br /> f FILES Specific addresses only,address ranges will not be acre ted <br /> rucund Tank(UST) Street <br /> y$ Street Name CitynfndaengpSila(LOP) <br /> []lr C <br /> E)MUI.ER <br /> � hCleanup SltNan-LOP) to(_ �Uj <br /> aard <br /> U DAIRY <br /> VElered Permliled Fedlity <br /> ""ground Tank �� 6� �� y�t� Z� <br /> r (Monilodng!Removal) ❑PWS <br /> V� ardous Materials 9 <br /> t11 ./ i 1�G1 u 1V r 1' <br /> SpIll!fiel"ase Response <br /> ®Solid Waste Facility 1 vehicle 4 13 WATER,QuurrY <br /> Food Facility 5 `f <br /> (�Pool d Spa ITICATto+v <br /> Dairy 5 }7 —7 <br /> © U' —�` h �, �_�Tc7�J 11]CCI <br /> ❑ P N_rx, <br /> Land Use Application Sites _ <br /> I ©Septic Pumper Truck 10 HOUSING <br /> 5 <br /> Yard!cttemicat Toilets Uj`o P <br /> WastewaterTrealmenl Plant to UPA <br /> ®Housing Abatement 7 p �Cj 1 C)�T i�t� � 37r,����G AST l HM l HW <br /> MctellHote] hk, 1 5 v `���[[[ <br /> ❑Chicken Reoch 1 Dog Kennel r-� t� CUPA <br /> ❑Medical Waste Facility 9 �� ��� Imo` ` r}� ',�� ���`�` I �,l�w�i UST <br /> F1 Tattooleody Pierc[ng lllTTT... 1 '✓ Gam_ L' �V�'r D SOLD WASTE <br /> []Waste Tire g 3 C) 1_2Tjj� <br /> complaint <br /> �Ulm LGV <br /> ❑Other(Please Specify): Acccurrnnc <br /> til <br /> -*BOXED AREA-EHD USE ONLY— <br /> r; A£:- <br /> 0 Records provided by Staff-PPR Complete. Starr Name: EHD 49.06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www,sjcehd.com <br />