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DAREIGOi ED EHD LOG NUMBER <br /> SAN AJOAQUIN COUNTY <br /> NOV 16 2016 ENVIRONMENTAL HEALTH DEPARTMENT 99671 <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232ENI/IRONMENTAL HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Svc y1 1k'C'e V- 0( 0 BUSINESS/AGENCY:SLv) 30C'QokV1 CUM ploluiCU10 <br /> ADDRESS: 1�9 1,O L- T H-G Z'Pit {'U✓1 I} 2 CITY/STATE/ZIP: `5,0 y <br /> PHONE(1): Z(?Cl- Ld 61& - 30 110 6 PHONE(2): FAX OR E-MAIL: 1 CACIC'CV f(,I c) A/•OR <br /> Please allow 10 business days from date of application submittal for the records to bailable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDIT IIF�cT._ EE(CljfiFi-QR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �.. d�1/� DATE <br /> s <br /> 1. List u to ten addresses pat a ow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one fi a 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 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> Specific Date Range of Information Requested: From ( to I <br /> ENVIRONMENTAL <br /> HEALTHFILESRTMENT FILE ADDRESS 2 EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street�# Street Name city vj <br /> CLEANUP SITE(LOP) <br /> ❑OTHER CLEANUP SITS(NON-LOP) "'� (f✓ 1 <br /> �HAZARDOUS WASTE �t^OI <br /> ❑TIERED PERMRTED FACILITY Z V` Cuf fa I 1'01 to W (Z 1"im�, O t /��/lVy ❑DAIRY <br /> ABOVEGROUND TANK l•� <br /> rn�UST (MONITORING/REMOVAL �o7o� Col-�a1 !'}oIlow � �/1_ �pyyg <br /> El HAZARDOUS MATERIALS ; N� I <br /> SPILURELEASE RESPONSE �'�(/Y�L( ��yy�� /L� f A--A o/J -r <br /> SOLID WASTE FACILITY/VEHICLE ` nLJLDtN l^pf YGAI I'}UIIDW RC.1 Tt-oLa�c� uh PO WATER OUKrtT L <br /> ❑FOOD FACILITY 0 � <br /> POOL/SPA V11 <br /> DAIRY 5 DE MMOATCH <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ []HOUSING <br /> 6 <br /> YMD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT r UPA <br /> ❑MOTEL/HOTEL <br /> CHICKEN RANCH/DOG KENNEL <br /> GUPA-UST <br /> MEDICAL WASTE FACILITY 6 <br /> F1 TATTOWBODY PIERCING <br /> n WASTE TIRE SOUP WASTE <br /> F1 COMPLAINT 9 <br /> ❑OTHER(PLEASE SPECIFY): <br /> 10 ACCOUNTING <br /> •'•BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />