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111 '""0011L.111 v E;LJ <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> •JAN 0 5 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> LWRONMEWALHF,�AM Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PENWfTr3ERVtr„" ' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Doi/p PQY0. BUSINESS/AGENCY: IL (einFP.�LIPT' <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1): D 351 -0332- PHONE (2): FAX ORE-MAIL: j�lpllf �XIPnfPI�Qr. <br /> eas 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 REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(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 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 /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> ❑UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SNB(LOP) I I D /"' /, ( 1- /+1 CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) <br /> ❑HAZARDOUS WASTE <br /> DAIRY <br /> ❑TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> UST (MONITORING/REMOVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS 5 <br /> SPILURELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 ❑WATER OUAUTY <br /> FOOD FACILITY <br /> ❑POOL/SPA ❑SITE MITIGATION <br /> ❑DAIRY 5 <br /> ❑LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑6 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL ❑CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING <br /> SO <br /> WASTE TIRE 6 UP WASTE <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): [I ACCDONTING <br /> to <br /> "`BOXED AREA-EHD USE ONLY"' <br /> S. 5 reef116 <br /> 7_ rummolp, <br /> Records provided by Staff-PPR Complete. staff Name: UV <br /> EHD 48-06 <br />