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RECEIVED4,4 <br /> Of 1"'`. <br /> SAN :J O A O O I N on 11 20IEnvironmental Health Department <br /> i f _—C A U N T Y - -- A Pke" 6 v-, PUBLIC RECORDS RELEASF APPLICATION <br /> ENV1Rl0NAi4FFJ*tAL FI LTH <br /> GreUtness c�rns�ls herr. 11 EWITi(SERMES <br /> Ca�CasScx:(cid--12S..1'_OlhEHD LOG Nt1MBER: <br /> �7 2.9.00v*7 <br /> APPLICANT: BUSINESS/AGENCY: c, Cn r'n o ry e. <br /> ADDRESS: (I(" IL Ung_ G.. IM �'1 '{� 11_Is CITYISTATEIZIP: <br /> PHONE (1): PHONE(2):-j Gq- �,-7--y1gJ FAX OR E-MAIL- <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will conyppropriate <br /> to roan an appointment Hate and time to review the requested ecor s. <br /> SIGNATURE OF APPLICANT _ � DATE C -LI <br /> j <br /> 1. List up to ten addresses ace below. Address ranges WILL NOT be accepted. Select the t pe(s of files from the <br /> list below by checking thbox(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@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 sante applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) f �t ❑CGNSUMER <br /> Z'Other Cleanup Site(Non-LOP) 1 6, Man +P't`A- IV <br /> ©Hazardous Waste _ ❑DAIRY <br /> O'riered Permitted Facility z (l Y) c�7_� <br /> [JA4oveground Tank <br /> ❑FWS <br /> �I.tST (Monitoring 1 Removal) <br /> [ Hazardcus Materials <br /> ®"Spill f Release Response <br /> ffWATER QUALITY <br /> Q`Salid Waste Facility I Vehicle 4 , <br /> Food Facility <br /> D Pool 1 Spa srrE MITIGATION <br /> ©Dairy 5 <br /> ❑Land Use Application Sites _ �r <br /> ❑HOUSING <br /> F]Septic Pumper Truck 1 B <br /> Yard 1 Chemical Toilets <br /> n Wastewater Treatment Plant COPA <br /> ❑Mousing Abatement 7 ASTIHMIHW <br /> E]MoteliHotel <br /> []Chicken Ranch I Dog Kennel Ej7euPA <br /> a UST <br /> 1]Medical Waste Facility <br /> ®TattoofBody Piercing S.I.WASTE <br /> ❑Waste Tire 9 <br /> [�complaint <br /> Other(Please Specify); E]Accau nnG <br /> 'Ea <br /> t "**BOXE!)AREA-EHD USE ONLY*** — <br /> Di�4rtle e71.r!•I'''n �C 1I�' tA�i <br /> 1• <br /> ❑ Records provided by Staff-PPR Complete. Staff Name; EHo46-os <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209�68-3420 1 F 209 464-0138 1 www.sjcehd.com <br />