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5 05/23/2017 11: 37 9166426668 AIR PAGE 01/01 <br /> •ow x:p <br /> -Iv AHD LOG NUMBER.1OAOUIN COUNTY <br /> 017 — <br /> A 2 47 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazdton Avenue, Stockton, CA 95206-6232 <br /> MkVjj%QNKWWAL FIF .fl"�Telephone:(209)465-3420 Fax: (209)464-0136 Web:www.sjgov.org/ehd qvIS5 <br /> ITS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � _ 1. 112ez BUBINESSIAGENCY: L <br /> ADDRESS: r' Y' tt I-01- CITY/S-rATEIZIP: LA&UQ �n - CA la <br /> PHONE(1): �>> �l2 t-[�ln rtJ PHONE(2): - FAX OR E-MAIL: .C4M <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> •,, ,NlII .., R "thespa <br /> TbelolwtSelect <br /> SIGNATURE OF APPLICANT DATE1. List up to en addresses a the types) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2(19)464-013&or mail tQ the address indicated above. Address <br /> ranges will not be accepted-Applications received after 3:40 pm will be processed the next business day. <br /> 2. For assistance In identifying the nature and content of EHD records, please contact EHD at the number noted above, <br /> Z. 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 behold 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$138 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map- Description, <br /> Specific Date Range of Information Requested: From t t to ?�►. <br /> FILE ADDRESS EHD USE ONLY <br /> U UNDERGROUND TANK(UST) Street# Street Name city <br /> CLEANUP Sl TE(LOP) []cofn/a'u�]Mcn <br /> OTHEF CLEANUP SITE(NON-LOP) t'"'M"-A1 LAAk— <br /> ®H4ZARDOUBVVA5TE ❑Gssm <br /> ®TIERED PERMITTED FACILITY p 1�� ` , �, u� .y <br /> 1 �ABOVEQROUNC TANK 1 �.�,,pr JJ .- �/ .31'f{`�'�Y�7fi/l/, r 1[,IY1�wr1 /'�/1�� <br /> LI (MUNI'TQRIN©1 REMOVAL} PW$ 4'`� <br /> HAZARDOUS MA.TERIAtS (�ti� 1, l�AA 64A.,14 <br /> SGILLIIZELEA.EE RESPONSE � <br /> AYER QUALITY <br /> yj SOLID wAETE FACILITY I VEHICLE 4Z 00❑FOODFACLrr <br /> POOL I SpA ,` !+ ` p �P `}� ] �r��A����j(/jJ(r) //I�TyE/MITI�T ON <br /> DAIRY 6 i U �/tL,-��� �l��ls �' LW {' !� Ali'"'.ii VV <br /> Q LAND Uel APPLICATION SITES - -- <br /> '�T �]HoualNa <br /> IJ SEPTIC PUMPERTRUCKI <br /> YARD ICHEMICAL TOILETS <br /> W)o �v <br /> F-1 WASTEWATERYREATMENT PLANT CUBA <br /> HOUSING AVATEMENT 7 <br /> MOTELIHOTEL - Y'�- ✓� I <br /> CHICKEN,RANCH I Doc KENNEL Cl1PA-ll5T <br /> ❑MEDICAL WASTE FACILITY 8 <br /> OLIO WA5TE <br /> F1 TATToo/BODY PIERCING - - . <br /> 0 WASTE TIRE <br /> 9 <br /> Ft]COMPLAINT <br /> D OTHER(PLEASE SPECIFY): E]Accs7UNGIN6 <br /> 10 <br /> O AREA-EHD <br /> v ' <br /> ❑ Records provided bV Staff-PPR Complete. Starr Name; <br /> Received Time=Mlay, 21. 2017=11 : 070 No, 1558 <br />