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RECEIVED <br /> atJIN�-, <br /> SANUJOAQUIN MAR 2s 201 <br /> Environmental Health Department <br /> • " ' <br /> —COUNTY <br /> — <br /> PU LIC RECORDS RELEASE APPLICATION <br /> cdci ¢ Greatness grows hePWOMMAILHIMM 1ilkl"R^'pp <br /> PEMWISEMbES �•`o EHD LOG NUMBER: <br /> APPLICANT: 'Sol-In /( nnetrf BUSINESS/AGENCY: HviI +f9Sioa10eJ")oL, <br /> ADDRESS: N llEmlf�r•re lvciy CITY/STATE/ZIP: $G �✓ o14 4N1 U(e <br /> PHONE(1): 4yo-Z32.-94yS PHONE(2): FAX ORE-MAIL: ', iLe�nedy@GI II(nt,.com <br /> Please allow 10 business days from date of application submittal for the records to be avai able. <br /> Staff will contactyyou to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT c-JO L-, L DATE 312`6118 <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)484-0138,mall to the <br /> address Indicated below,or email to info(a)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 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. u <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. L <br /> Future file reviews 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:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From Ear Ir MJF a VG(I It to tM avJh Z"u/Za(8 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) <br /> FILES EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑Caxsurnan <br /> Oi Mo win+ �D`"` Mcnk-t �0 <br /> Other Cleanup Site(Non-LOP <br /> • Hazardous Waste ODAIxY <br /> (Tiered Permitted Facllity z cc. <br /> Aboveground Tank <br /> UST (Monitoring/Removal) /�// Pws <br /> 3 <br /> Hazardous Materiels <br /> Split/Release Response AiEa Ouum <br /> Solid Waste Facility/Vehicle 4 7 l�I 1 r S�cb- <br /> ❑Food Facllity I v p srrs MmaAnox <br /> Pool f SPa 7 y p, 1 /1 y�n �IL <br /> 5 1T� IVI� IV�.I'l"Jt v(/ <br /> Dalry <br /> ❑Land Use Application SitesD Housix0 <br /> Septic Pumper Truck f a / ' <br /> Yard/Chemical Toilets 11 <br /> Wastewater Treatment Plan[ grCUPA <br /> Housing Abatement y AST/HMIHW <br /> ❑MateUHotel 'e' <br /> �]Chicken Ranch f Oog Kennel UST <br /> Medical Waste Facility <br /> e 71 Z <br /> E]Talloo/aody Piercing SOU1 Winn: <br /> Waste Tire a <br /> Complaint <br /> ❑Other(Please Specify): Aooeuxnxa <br /> 10L= <br /> *"BOXED AREA-EHD USE ONLY"' <br /> 3X45 trs i s r e llecw 0� , s r k c,,& e "tji <br /> 0 Records provided by Staff-PPR Complete.stain Nam.: EHD4e4S <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />