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RECEIVED <br /> SAN JOAQUIN <br /> JA ' 23 2�'�?,Environmental Health Department <br /> t6't-ei 3 /'� PUBLIC RECORDS RELEASE APPLICATION <br /> —COUNTY---- � pk�gL�}{ <br /> • : .. _.. n: PEPtimmSEFmimB 107 f37 V <br /> EHD LOG NUMBER: VV <br /> APPLICANT: SINESSIAGENCY: ,I !r' <br /> ADDRESS: �7 ' Y 00 CITY/STATE/ZIP: <br /> PHONE(1): �✓9� "\-1 13`LS PHONE(2): FAX OR E-MAIL: e r" kl <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT Z DATE !-7.5'iq <br /> 1. List up ten addresses in the space belowr�ress ranges WILL NOT be accepted. Select the type(s)of files from the <br /> to <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464.0138 mail 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. <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$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: E.List al Map–Description: All Fj le5 <br /> Specific Date Range of Information Requested: From 1- I to j Z� Oil <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> FILES <br /> Undergmund Tank(UST) Street# Street Name City <br /> Q CGNSUMEP <br /> Cleanup Site(LOP) .,I l� r �,r <br /> • �jl Other Cleanup Site(Non-LOP) <br /> ��( <br /> v�Hazardous Waste %( ❑ouPr <br /> �0F ir, <br /> Tiered Permitted Facility Z n <br /> Aboveground Tank ° �- (-'A (]!] ❑ <br /> PWS <br /> UST (Monitoring I Removal) <br /> Hazardous Materials <br /> Spill/Release Response /CC X7v t� W^TSP OuAum" <br /> E]Solid Waste Facility/Vehicle q <br /> Food Facility /V n'"I".TIU -'�.(�) SMl <br /> SRE MRIGATION <br /> OPool/Spa , 3z1 S p, -kel s Ave. r-t(,A�ec�, VIIRjP/ 'h1j�Cl lr1� <br /> Dairy <br /> E]Land Use Application Sites ❑HUusiNG <br /> Septic Pumper Truck/ a <br /> AA— <br /> Yand I Chemical Toilets L CUPA <br /> ❑Wastewater Treatment Plant <br /> ASTIHM/HW <br /> ❑Housing Abatement 7 <br /> 0 Motel/Hotel ❑CUPA <br /> F1 Chicken Ranch/Dog Kennel UST <br /> 8 <br /> ❑Medical Waste Facility <br /> F1Tattoo/Body Piercing E]SOLID wnss <br /> Waste Tire 9 <br /> E]Complaint ACCOU"NG <br /> F1 Other(Please Specify): <br /> to <br /> "*BOXED AREA-EHD USE ONLY"` <br /> 0 Records provided by Staff-PPR Complete. Staff Name: EHD ae-os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 l T 209 468-3420 F 209 464-0138 www.sjcehd.corn <br />