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Eno,r231701:42p Phase1Assessments 916-988-6639 p.1 <br /> RECEIVED r EHD LOG NUMBER <br /> • <br /> Elio <br /> RECE 2 3 201`7 ',;yll SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> -- C11 PUBLIC RECORDS RELEASE APPLICATION <br /> //-- <br /> APPLICANT:J_ARS�/7,'4Jice,.!-BUSINESS/AGENCY: <br /> ADDRESS: 2- 7-3 �/I67VA .U- Z>41151 CITYISTATEIZIP:ga,!j- � , CA - .3 <br /> r 0 <br /> PHONE(1): e L Z.PHONE(2): FAX OR E-MAIL' /Z1 4 J /Y.H,S-,C `t�- <br /> Please allow 10 business days from date of application submittal for the records to be available.,f_cSd'CS 4rI6: / - <br /> Staff will contact you to arrange an appointment date and time to review the requested records.? <br /> ❑CHECK BOX 70 EXPEDITE RE -OR CHECK ONLY-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 —Z3 — —e/ /y <br /> 1. List un to ten addresses in the space below. Select ffie^typ (s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091 Q4-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pmwill 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 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$139 deposit prior to review. <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 /> Speck Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGRWND TANK(UST) Street# Street Name city <br /> IFAllUPSITE(LCP) / ❑COASLMEP I <br /> OMER LIFANUP STE(NON-LOP) <br /> T 0T �AAL5tdULb 1>6 s 3 31 <br /> 1eHAURDouswasr- ❑ <br /> in<mr <br /> IIIIYYYffRII TIERED PERN:=D FACILITY j j <br /> ' I,�U AROVEOROUND TANK 7 tl/ �ylrY/ r'r �11911/r�'ra./LYJ!✓.�'p <br /> 1�ST (!IIONROPINCCRFAIW d� 0P <br /> ATAfa7OUS UL <br /> MATER $ ] * 4 , �/ <br /> ❑SRLURELE/sE RESPONSE / / / }L <br /> WAIEfl DVPLIiY <br /> ❑SOLID WASTE FRCiUTYI VEF[ICLE a <br /> FOOD FACILITY , <br /> POOL l SPA 9TE MaIGRwn <br /> °D,iRY6 p�u <br /> ❑L v USE A RJCA DN ST <br /> E]SEPMC PUMPER TRUCE! HOti <br /> fi M <br /> YARD f CI✓EURUI TOHETS ,S 1 1 1 <br /> ❑wmTEWATQi TREAT rf`L T <br /> CUPH <br /> ❑HomiNG ADA .ENr I T <br /> Mom)HCI EL <br /> CIDCREN RAKCH I DOG KENNEL 5Z CUPA-U.T. <br /> hlmu; I WA FAC[ a <br /> Il TATMQISDDY PIERC.O <br /> ❑ TIRE WASE_ \\Q S011D WM1SIE <br /> 9 <br /> CQdPW VT <br /> OWER(REASE SPECIFY): <br /> Q ACEoDRIING <br /> ID <br /> ""BOXED AREA-EHD USE DNLY— <br /> ❑ cords provided by Staff-PPR Complete. sca Nzn,o: <br /> EHD -06 <br /> Received Time Mar, 23. 2017 1 :40PM No. 1092 <br />