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SAN JOAQUIN KtUt:14k,...entao Heallth Departmerk <br /> COUNTY-- MAR O 7 20I8 PUBLIC RECORDS RELEASE APPLICATION <br /> :i1i{I;;__P`' Greotness 9row5 here ENIARONMENTALHEALTH <br /> PERMI EHD LOG NUMBER: <br /> •PPPLICANT: G—' <br /> /d7�Z BUSINESS/AGENCY: <br /> ADDRESS: V3 /—'grCITY/STATE/ZIP: <br /> PHONE Ll): �E,307�J3 PHONE(2)VP� b/5M_"3 _FAX ORE-MAIL: <br /> IT// Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will co you to arrange app tment date and time to review the requested records. <br /> SIGNATURE OFAPPLICA ( DATE ,? -"3,/, <br /> 1. List up to ten address In the space below. Ad r 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)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. 3/� <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 to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES ( ) <br /> Specific addresses only,address ranges will not be accepted EHD USE ONLY <br /> qq /y <br /> N Underground Tank(UST) Street# Street Name city OC '/ i8 <br /> q <br /> Cleanup Site(LOP) t L MtL ` _)3 xf)nn7'11 <br /> ®Other Cleanup Site(Non-LOP) <br /> Hazardous Waste <br /> Tiered Permitted Facility 2 a / //�'%✓l�'� 'VV 1 '1 Z4 /uQ� O aaq'/99`Y <br /> E]Aboveground Tank A // /Q <br /> UST (Monitoring/Removal) �T /,//) C" <br /> Split <br /> HM_ y ,titrnoe LLYC�/R.�.va-'CPA— <br /> L. <br /> `[]Hazardous Materials a 3d-3 "V (/��R^' r'�VS-1... JC,2.t1� f <br /> Spill/Release Response <br /> WATER QaaLIV <br /> E]Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> Pool/Spa Cj�trni Mn1aATON <br /> Dairy 5 <br /> Land Use Application Sites <br /> [j Housisc <br /> Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 ASTI HM/HW <br /> Motel/Hotel <br /> F1 Chicken Ranch/Dag Kennel ❑CUPA <br /> 8 UST <br /> Medical Waste Facility <br /> Taaoo/Body Piercing E]SOLID WAare <br /> �]Waste Tire a <br /> Complaint <br /> Other(Please Specify): ❑Accourmxc <br /> 1R <br /> ***BOXED AREA-EHD USE ONLY*— <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjoehd.com <br />