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■M r[e a sessments <br /> KME VC <br /> • 916-988-6639 p.1 <br /> ■ <br /> ■� DATE HE6XI A 2017 <br /> !Jt£N� Al <br /> MMItON ) SAN JOAQUIN COUNTY EHD L06 NUMBER <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ni PEMIT�E°2 1�F E.9 1866 East Hazelton Avenue,Stockton,CA 96205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:wWw.sjgov.org/ehd <br /> APPLICANT: <br /> �t PUBLIC RECORDS RELEASE APPLICATION <br /> ,T� <br /> ADDRESS: USINESS/AGENCY: <br /> PHONE(1): / CITYISTATEI IP: , <br /> PHONE(2): -1 <br /> lease allow business days from date' <br /> application submittal for FAX records s to by ai bte. <br /> Staff wilf Contest you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYSi r� <br /> SIGNATURE OF APPLICANT <br /> 1. List uo to ten addresses in the space tx;low. Select the a DATE <br /> box(es). At least one file tyP (s)of files from the list below by checking the appropriate <br /> type MUST be selected, Fax to 1209)464-0136 or mail to the address indicated above Address <br /> ranges will not in accepted,Applications received after 3 00 pm well 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 /> 3. The EHD will notify the applicant if any EHD{les 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 fife reviews by the same applicant may req uire a$139 deposit prior to review, <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0UPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: [I List❑Map-Description: <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL to <br /> HEALTH DEPARTMENT <br /> FI FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNpEFGRDTANK(()STJ Street Street Name <br /> CLEANUP SITE(LOPI city <br /> ❑OT ER CLc.ANUP STrE(NON-LOP) r I''� ❑ suNER <br /> HauRDDus WAs7E '. 'r <br /> q����//////TERW PERMITrW FAGLLrtY Z f]Duar <br /> ASOJEGRODND TANK <br /> A ' J, <br /> UST (MONDDRMG/REMWAL) <br /> 13 HALMDWS MAT ILS 3 ❑PVYS ��� <br /> I l SPYIJREE EASE RESPONSE 6? <br /> Y❑SOLID WASTE PAMN/I/EHIpLE <br /> 4 11 r^ , �//-�y/7 Wn'IERQWVfIT <br /> ❑FOOL FAA <br /> ❑POOL/$Pq <br /> ❑DAIRY 5 ��� b�i M t- �f� ❑GnE MlicnTory <br /> ❑LAND USE APPLICADON SDE$ <br /> ❑SF PJNPERTRUOK/ <br /> YMD/CHEMICPLToC E ❑HDUSwG <br /> ❑wAS1EWATER TREATMENT Ptarr <br /> ❑HOUSINGASATEHENT T UPA <br /> [-IMOMLIHOnL <br /> ❑CHICKEN RANCH/DOG KENNEL <br /> ❑MEDICAL WASTE FAgLnY B <br /> CUPA-OST <br /> ❑TATYpDIRLDv PlmpwG <br /> ❑WASTE TIRE <br /> ❑CONPLANT s ❑SaLn WASTs <br /> ❑OiHEq(PLEASE$PEOFY): <br /> in <br /> ' D/�OUNnIrc <br /> —BOXED AREA-EHD USE ONL <br /> p <br /> Records provided by Staff-PPR Complete. smn Named <br /> EH04B-0E <br /> Received Time Mal 28. 2017 1 :49PM N0. 1114 <br />