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RECEIVED <br /> DATJ?AArI Q q 201 EHD LOG NUMBER <br /> EE L SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t£ERfONIVIEWAL HEALTH 1868 East Hazelton Avenue,Stockton,CA 95205-6232 1 /� J. <br /> PERMITw. <br /> /SEWCES Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwsjgov.org/ehd [ (� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> APPLICANT: i, BUSINESS/AGENCY: (.rl')vc>>' (-.',I -ul lardy _ <br /> ADDRESS: tIFLib H01 �jT `:r 1L CITYISTATE/ZIP: <br /> PHONE(1): `I1>-7R4-41-1 ef-t PHONE(2): FAXORE-MAIL: <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 /> ❑CHECK BOX TO EXPEDITE REQU, -$130 FEEr (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '�41y1.r ��"i ',r Y� DATE CI 111ln <br /> 1. List up to ten addresses In the space below, Select the type(,)of files from the list below by checking the appropriate <br /> bO (es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 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 /> 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 asreleasedwill be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 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 <br /> HEALTH DEPARTMENT FILE ADDRESS 3 <br /> FILES EH®USE ONLY �l <br /> I iD UNDERGROUND TANK(UST) Street q Street Name City <br /> CLEANUPSITE(LOP) `� ��n-� GONSWEP <br /> OTHER CLEANUP SITE(NOR LOP) 1 )(L�[j )'4 LiIUIW T"L'L'+C� '!�( UO \ _— •1 <br /> ©HAZARDOV6 WASTEf DAIRY <br /> E]TIERED PERMITTED FACILITY 3 ))1 / • ♦ ♦ ,'D /1�1/ I N✓ABU2LG IV L,LI'tll1�� (�.pr'C. 6 1 A <br /> 0 PR'S <br /> y�UST (MONRMATERZORING I RENOVAL) 3 1 T A/O �fi LA41/jD� <br /> O HAZARDOUS MATERINL6 ) 1 1 Z 1 t, (,l,ItR l l� )_tH:�� I`� <br /> SPILLIREWAfiE RE6PoN6E L L Y t f I ��//uu <br /> ❑SOLID WASTE FACILITY/VEHICLE ♦ <br /> ❑FOOD FAcnm <br /> ❑ <br /> SITE MrtIGAnp1 POOL/SPP <br /> ❑DAIRY 6 <br /> ❑LAND USE APPLMATICN SRES Ho051 <br /> SEPTIC PUMPER TRUCK 1 f ( .n�� //(� /L ��J /[y/5 <br /> YARD/CHEMZALTmeTS If /L/V V'��'�lN �l� 606 <br /> ❑WASTEWATER TREATMENT PLANTy N� CUPA <br /> El HORHRGABATEMENT 711 i 50 1f�i N <br /> ❑MOTEL/HOTEL 1 JCl L J L IiC��I �C%iIC� • ♦� �i 0 t I /./ <br /> iM CHICKEN RANCH I DOG KENNEL y CUPA-HAZ-MAT <br /> ❑MEDICAL WASTE FACILITY <br /> )]TATTOOIBODY PIERCING SOLO WASTE <br /> (�WASTE TIRE <br /> ErCOMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ❑AcmuR RNO <br /> 10 <br /> —BOXED AREA-EHD USE ONLY" <br /> L 0W — US 1 ZO I Z . 44,0d .h <br /> i5 it <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD U-06 <br />