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aLoa.z5 RECEIVED <br /> SAN J OA Q U I N JAN 2 4 201�Environmentai Health Department <br /> COUNTY —- Gly Eel 3Opn PUBLIC RECORDS RELEASE APPLICATION <br /> EHD LOG NUMBER: <br /> 67079 <br /> APPLICANT: Jt0,te_ f3ERGm4tV BUSINESSIAGENCY: J.,+. At7'2.GMA.t <br /> ADDRESS: 57P w,*,,ylFraarr—ro,4) AL-Vb &-yit CITYISTATEIZIP: OMAAimA-'A. ft CA- 'jOa? <br /> PHONE(1): 310 .g171-2377- PHONE(2): FAX OR E-MAIL: �4hi®au Il;be , <br /> Please allow 10 business days from date of application submittal for the records to be availabl . ALI <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT AN &C.AjrryKv DATE /�/7 /201& <br /> 1. List up to ten addresses in th space below. Address ranges WILL NOT be accepted. Select the types)of files from the <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 infoosicehd.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. /Z <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 16t f 6— to C,LkAUA-+- <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Took(UST) Streets Street Name city <br /> Cleanup Site(LOP) I-1Nll . ❑cauwen <br /> E]Other Cleanup Site(Non-LOP) a 241.15' W�T CW"_r S.Tp --tI <br /> [�'Haxallous Waste /L r4-./ D Dem, <br /> Tiered Permit Facility Z U'T IJQ\p CD1�r�" }'-/Rr�'t+HNj <br /> • Al,avegmund Tank a <br /> UST (Monitoring/Removal) d\ L 3C� D� <br /> .[g+wmdaus Nationals a �3 t. tlif <br /> EgApill l Release Response t V� <br /> El Solid Waste Feciety I vehicle . :9/n/rs s �v{a.sr„ GebK WUTw I nv <br /> C]Food Fatality II�.1,. `� tt <br /> I1 Pool I Spa )� bS A�oC.I W Cl Sea Mmosnoo <br /> ❑Dalry 5 J <br /> Land Use Application Sites a dA 1k SSA, - „'(j <br /> []Septic Pumper Truck l 6 W I T s DO Lo-C tt'eyt". IAL. ❑Houav 6 <br /> Yard I Chemical Toilets bAL0-e_Aav% t f- <br /> ❑Wastewater Treatment Plant A UPA <br /> ❑Housing matemenl T bl-rC6 tavL ASTIHM/fiW <br /> ❑MntelMot.l DIM 7R4ulrs^- <br /> Chicken Ranch I Dog Kennel . N OlQ ❑CUPA <br /> Medical Wast.Foam, ,I R Pq w u� UST <br /> Tallodeody Piercing G 9 n a/� <br /> Waste Tire 9 Y frr{{Tyy V +f.Cz)c( 141? t ❑Soto Wgasa <br /> D Complaint �Q IL qjS CT e <br /> Omer(Please Specify): p Accavxrnc <br /> ,a C.ySc No. 2�7foo f>J J' suP.ctret„ <br /> •'BOXED AREA-EHD USE ONLY." <br /> ❑ Records provided by Staff-PPR Complete. sten Nam.: oxo teat <br /> 808 E. H [ton Avon e 1 S ckton,Califomi 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> • ,g bra 1 a��,� , .� � roj 1 ,��°5� I clw�n�` <br /> c{' l HS7-`. -r-or ISI <br />