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* �b 13 18 10:28a Phase 1Assessments 916-988-6639 p.1 <br /> �. RECEIVED <br /> i <br /> SAN JOAQ U I N FEB 13 2018 Environmental Health Department <br /> - C O'—IN T Y.OMPOONAWMALS PUBLIC RECORDS RELF-ASE APPL! ATION <br /> �1� EHD LOG NUMBER: <br /> APPLICANT: P—H -S�� VA-� I L BUSINESSIAGENCY, -P Of ll L -- - <br /> ADDRESS: n 3 �y /= CiTY1STATEIZIP: /-0LO-M 4 <br /> �Q �f <br /> PHONE(1): (-q (0,)gil PHONE(2): FAX OR E-MAIL: <br /> Please:140W 10 business days from date of application submittal for the records tQ be available. <br /> Staff will contact you to arran la a lntment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT —� DATE <br /> 1. List up to ten addresses in the .ace beo[ w. Addr6ts.calljnges WILL NOT be accepted. Select the fypll of files from the <br /> list below by checking the appropriate box(es). At least one-£i1,,e type MUST be selected. Fax to 209 494-0138 mail to the <br /> address indicated below or email#a info icehd.com. Applications received after 3:DO prn 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 FHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. f � <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ Lisi ❑Map—Description: <br /> Specific date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD I I S F ONLY <br /> Underground Tank(UST) street# Street Name Citynn � Q <br /> Cleanup Site(LOP) .� ( /( - l CONSLINER <br /> ra <br /> Other Cleanup Sate(14an-1_oP) f�l I <br /> ��Tr _Waste <br /> Hazardous ilfteditted ( R <br /> erad PermFacility 2 �Y 1`Cl T�� }•'eiM�t rJI/L�.B�"K� <br /> ( Aboveground Tark ^�`-'7 7 - f � I�'1/N t -l�tr�+ ✓►1J1 ' <br /> 5'UST (Monitoring i Removal) +- t,�►A1 /1 J" 1n 1 P g <br /> Q Hazardous Mater als 3 367 r �A A �/�y ( } a 1 !l <br /> 1� /�, J� V v � <br /> (�Spill!Release Response L- rT f 61/i (�I[-, (�j�(f L:, <br /> Solid Weste Facrtty 1 Vehicle a 11 YV c aT 4ue.ry <br /> ❑Food Facility ZJ.? � /1�� <br /> •�'Zl/' 1 �� Al'\ l� <br /> Il Pcol A spa SITE MlylswIct. <br /> ©cialry S' <br /> Land Use Application Sales <br /> Q Sepffe Pumper Truck J 6 C ❑Hw srNc <br /> Yard!Chemical Toilets t / <br /> Wast'. W <br /> Wastewater Treatment Plan[ <br /> (�i-imising Aba-,emert 7 ^ ASTf KMIH <br /> M <br /> ❑Chicken Ranch I Col;Kennel f/� CUPA <br /> ❑Medical Waste Facility a � � ` -�{ � � ; UST <br /> ®TatlaOlBedy PiercingEl y ` <br /> ❑ a wrsTe <br /> waste Tire g . <br /> 0 Complaint <br /> �(Other(Please specify): <br /> 10 ❑ACG4unnNG <br /> L L <br /> —BOXED AREA-EHD USE ONLY*'• <br /> © Records provided b Staff-PPR Complete. staff Name: -1110)4II-05 <br /> 1368 E. Hazelton Avenue I Stockton, California 95205 ( T .209 468-3420 j F 209 464-0133 1 vvuvw,sjcehd.com <br /> Received Time Feb, 11 2018 9 : 31AM No, 3052 <br />