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- ECE'1V ' _ . -- <br /> DATE Rfi�y}yy/EP 0 2016 <br /> �ev� U () ' SAN.IOAQUIN COUNT N� ' EHD LOG NUMBER <br /> ENPERMIRSE q1H VIRONMENTALHEALTH on, A9520 850 <br /> 1868 East Hazelton Avenue, Stockton, CA 9520 -6232 J` <br /> PERIHI7/$ERVICE$�m Telephone: (209)468-3420 Fax:(209)464-0138 Web:www,$)gov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: e S E- �- �s BUSINESS/AGENCY: <br /> ADDRESS: J g p /J/-o I r C{ e C I r- S f 3 zo CITY/STATE2IP: �Q fi I <br /> PHONE(1): �/b CL C 4 3 F I PHONE(2): _ Sa c i Cq a 5'd 3 41- I <br /> FAX OR E-MAIL- - j6�, Ct Irt�TfP rr�ly �. <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. Cb <br /> H taceoxTOExPeplr REoE 'I1a$,1EYcntttl�cHccoNL.._ ' dt!- �,� Q�Ess�-0ll. t�ttusp _ <br /> SIGNATURE OF APPLICANT <br /> 1. List uD to ten addresses in the space b ow Select thee ss of files from the list below by checking the appropriate <br /> box(es). At least one file bP ( ) <br /> type MUST be elected. Fax to(2091464-0738 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:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: EaList❑ Map-Description: q L, dam+r <br /> Specific Date Range of Information Requested: From 9 9 p to re f <br /> L 11 G(� K� ) <br /> "_9dIpaRTM + f FILE ADDRESS EHD USE ONLY <br /> Plus 11 <br /> UNDERGROUND TANK(UST) Street# Street Name city 'I <br /> LEANUP SITE(LOP) <br /> 11 �f' ❑ VMER <br /> ER CLEANUP SDE(NON-LOP) 1 3N D v COrf"(,(� �Of��4� �C�� Trer G / CA"Nou i I e014 <br /> RDous WASTE //�� / n 11 <br /> PERMITTED FACILITY 2 311 U S, C.O rrec l-{�/�ULV 90^j y lAe <br /> KX—GROUND TANK QQQQQQ ,,,���11111T I ` G7 , CAVg(t5T <br /> T(MONNORING/REY N� f/VV -/t�� PWB <br /> TER3 ,7V/V / .\ corM �IlflW � V W <br /> F11LUJ=RE.Z:SEV __llVVW WASTE FACILITY I VEHKAE 4 tI " /� f Iv WATER pWDY <br /> ❑FOOD FACILITY $ D <br /> ❑POOL/SPA <br /> DAIRY 6 SITE MTRGLTON <br /> (AND USE APPLICATION SAES <br /> ❑SEPTC PUMPER TRUCK/ El H�IYH� <br /> YARD/CHEMK:AL TOILETS <br /> ❑WASTEWATER TREATMENT PIANT 6 <br /> HOUSING ABATEMENT T LPA <br /> iHOICTEKLEINHOTE <br /> L <br /> RANCH/DOG KENNEL <br /> iEDM.AL WASTE FACILITY 6 COPA-UST <br /> IATTOD/BODY PIERCING <br /> ASTE TIRE BOUD WME <br /> 3 <br /> COMPLAINT <br /> ❑OTHER(PLFASE SPECIFY): <br /> ELI ❑ACCOUNTIxG <br /> "'BOXED AREA-EHD USE ONLY'** <br /> 'ha/ <br /> ❑ Records provided by Staff-PPR Complete. sniff Name: <br /> EHD 46.06 <br />