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RECEIVED <br /> S A N J U A Q U I SAY 25 2018 Environmental Health Department <br /> CC)U I.J T EWlWaCK.ALFMW PUBLC RECORDS RELEASE APPLICATION <br /> PERMIF11719 An we <br /> !THYEMAIL ' ±�pl EHD LOG NUMBER: Vvr73P <br /> APPLICANT: K4t'!gar" D4'/¢ j BUSINESSIAGENCY: <br /> ADDRESS: 102.1 C. HAat,(J1y^ A,,/kAy-(_ CITY/STATE/ZIP: <br /> PHONE(1): L191U)2ycp -1b9 7� PHONE(2): FAX OR E-MAIL; NIL�a,n,D4.tl+.r EtrfcL(zrt. <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contactou to arran an a ointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT y � DATE <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138, mail to the <br /> address indicated below,or email to infoCdsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:001PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List 0 Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS 7/1 uS T 5 11`1 <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> UndergroundTank(LIST) Street# Street Name City <br /> j Cleanup Site(LOP) ❑consuraEP <br /> Other Cleanup Site(Nor+OP) 1 �-1 �, f{ -pY-1 AJEJ I G a! y ,g Q <br /> ' Q Hazardous Waste ti.' t41k e� (,)� <br /> ®Tiered Permitted Facility 2 1033 f aYt <br /> � ,( <br /> fR Aboveground Tank '�'Iff <br /> UST (Monitoring I Removal) y+"lrltM.t'l7T lAl - tolS phi (Z � <br /> Hazardous Materials 3 !JJ Gq f 7Tv i{/l V-Q, p(� p <br /> Spill I Release Response _ e n e 9 <br /> lktr\ ,L� 4 �r`� O✓Llf Warsa(]un� (� <br /> Solid waste Facil ty!Vehid dl�� �A / w� <br /> ❑Food Facility 4 �y6 S, JY1ia✓l1YL+2I r) <br /> ❑Pool J spa rr x+-711 hi� lit�'(�PP. O x,5 lC)f SITE P tmcarinr+ W <br /> ❑Dairy 5 �Q �. I O tri._ d^ Li l` L.lL41r.)a Iv9 <br /> Land Use Application Sites <br /> L-J Septic Pumper Truck! N( tilt (44 l�J�^ 0c2 <br /> e {n3S �, R(ivO r'Gl t C k�t�tn <br /> Yard!Chemical Toilets S4-o <br /> wastewater Treatment Plant UPA <br /> IJHousingAbatement 7 ASTIHMIHW <br /> El Motel/Hotel <br /> Chicken Ranch(Dog Kennel CUPA <br /> 8 <br /> Medical Waste FaciFty UST <br /> n Tattooll3ody Piercing tgIGOLID WASTE <br /> FJ Waste Tire y <br /> ❑Complaint <br /> ❑other(Please Specify): ❑AccouMTnO <br /> 1U <br /> " BOXED AREA-EHD USE ONLY— <br /> 1tL r(Lr,; i 4 ,li- lzt, :i �. <br /> ❑ Records provided by Staff-PPR Complete. staff Mame: €r©aa•os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />