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-�d.25 RECEIVED <br /> SAN 'O A Q U I N .SAN 2 4 20jrEnvironmental Health Department <br /> C CSU N TY -- -- 3,-�Y--\ PUBLIC RECORDS RELEASE APPLICATION <br /> -RONUNIAL"Mm 07-n <br /> EHD LOG NUMBER: 1�79 <br /> APPLICANT: �V► f�aE14�,rfrar,! BUSINESS/AGENCY: J.A., 96yU,/n, ., <br /> ADDRESS: 57Q L0&.s facr-roo g[..UD ' S'Y'f CITYISTATEIZIP: _MAArAth- Aj- Ray CA- +ro�Uga <br /> PHONE(1): 31:0 -g'l I.2-3,7,;L PHONE(2): FAX OR E-MAIL: � ��{�6��.�.i•�,,� <br /> Please allow 10 business days from date of application submittal for the records to be avaiiabl . <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT "A-f A— ��N _ DATE Z01 fr <br /> 1. List up to ten addresses in thLWspace 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(2091464-0138,mail to the <br /> address indicated below,or email to info@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. - f <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑List E]Map-Description: <br /> Specific Date Range of lnformatidn Requested: From to C-trl,+y LA4- <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y 9 p ) EHD USE ONLY <br /> FILESILES (Specific addresses only,address ran es wilt not be acce ted <br /> n Underground Tank(UST) Street S street Name city <br /> Cleanup Site(LOP) I-AIM`,I-k{,,/t Q ❑Corsuuep <br /> Olher Cleanup Site(Non-LOP) t ZV45- k5e-ST C l.ifTWV -Mck--tdhl <br /> [j]44azardous Waste <br /> rA#"1 poen <br /> ❑Tiered Permiitad Facility 2 !+iA-�/( <br /> ❑Aboveground Tank - C lltevv. y <br /> ®UST (Monitoring I Removal) in � C._ PWS <br /> azardous Materials <br /> [gApill J Ralease Response <br /> ❑Solid Waste Faci3gy I Vehicle 4 d 5 a Wi400(�(j WATER QUALME]Food Facility I <br /> Fj Pdol 1 spa 7td: I>5 wqc, SITE Mmotir109 <br /> ❑Dalry s <br /> ex <br /> Land Use Application sales _ 'Q d A Of <br /> Septic Pumper Truck! 4 t,.1.4 ® <br /> Fpa Ljo <br /> Yard 1 Chemical Toilets „G�,RM �•p2PAf— <br /> F1 Wastewater Treatment Plant UPA <br /> Q Housing Abatement 7 DITCa Inst-- AST IHMIHW <br /> ®MotellHalel P►7 Co 7letEckIA- <br /> Cj Chicken Ranch 1 Dog Kennel ❑CUPA <br /> 4 <br /> M Medical Waste Facility `e. V� UST <br /> ❑Tattoel8ody Piercing 1 - <br /> waste lire e <br /> f]�'LDuJAsTE <br /> Q Complain[ Plop I L Ofs' C-+ y 5 <br /> Jr n- <br /> Other{PleaseSPecfiy]: 10 lc. k- �� I10O 1Atr 50,PAtfDZ ❑�rovaT�c <br /> *"BOXED AREA-£HD USE ONLY- <br /> 4 <br /> CI Records provided by Staff-PPR Complete. Staff Name: EHD 411-ob <br /> 1 B 8 E. HaAelton Av{en e) S ckton,Califoml 952051•�T�209468-34201 <br /> 09468-3420 ( F 209464-0138 1 ,wyw-�w.sjcehd.com <br /> �� ,A"tJ�� <br /> C} "U <br /> �J C ( ' &bt� t� l /9 <br /> Vcow l� 3 J M OW Com. 2 4mO P5 i C cs►�c � � �. <br /> � � 7S <br />