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-ECIVED PEP <br /> 101111110 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> OCT j3 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> aVtTelephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> � OerY �ITAt PUBLIC RECORDS RELEASE <br /> APPLICATION <br /> APPLICANT: rL- <br /> ADDRESS: BUSINESS/AGENCY: <br /> PHONE(1): CCITY/STATE/ZIP: rr 3 <br /> PHONE(2): FAX OR E-MAIL: <br /> PI ase allow 10 business days from date of application submittal for the records to be av lable, <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE EQUEST 139 F ( ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> 1. List up to ten addresses in the s below, ect therom DATE&kh� r <br /> box(es). At(east one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated abohe list below by cneCKing the ve. 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 <br /> 1.1-19CO to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> 17(I UNDERGROUND TANK(UST) Street# Street Name <br /> T CLEANUP SITE E(LOP) City <br /> / I ❑C <br /> OTHER CLEANUP SITE(NON-LOP) �T� 0� ONSUNIER���� <br /> HAZARDOUS WASTE p <br /> TIERED PERMITTED FACILITY ��((�� n l p'-V� \\\ 11 DAIRY <br /> 2ABOVEGROUND TANK I-1100 S h I dC/ Pkvi I �,,{�-r� ��,n %1-011 c o <br /> UST (MONITORING/REMOVAL) <br /> AHAZARDOUS MATERIALS {r ❑PWS <br /> SPILURELEASE RESPONSE 117('ID <br /> SOLID WASTE FACILITY/VEHICLE / WATER M? <br /> / <br /> ❑FOOD FACILITY QunLrry ( <br /> POOL I SPA <br /> DAIRY 5 rrE MITIGATION <br /> LAND USE APPLICATION SITES �I <br /> SEPTIC PUMPER TRUCK/ 1/` <br /> ❑ <br /> YARD/CHEMICAL TOILETS 8 HOUSING <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT T CUPA <br /> MOTEL/HOTEL <br /> FICHICKEN RANCH/DOG KENNEL <br /> ❑MEDICAL WASTE FACILITY 8 CUPA.UST <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE <br /> IyQ COMPLAINT 9 SOLID WASTE <br /> ❑TOTHER(PLEASE SPECIFY): <br /> 10 ❑ACCOUNTING <br /> "'BOXED AREA-EHD USE ONLY— <br /> / <br /> i <br /> ❑ Records provided by Staff-PPR Complete. scall N�mc: <br /> EHD 48-06 <br />