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RECEIVED <br /> SAN J QA Q U I 1AY Z 5 2018 Environmental Health Department <br /> C C-)U NT ''r' PUBLC RECORDS RELEASE APPLICATION <br /> PEnw` IT SY EMMAIL T ''h <br /> 'L� EHD LOG NUMBER: � 7 3 <br /> APPLICANT: K4JCI P"L DA,Ue.�-� BUSINESSIAGENCY: -f`L�c_Lotr4 <br /> ADDRESS: )02,1 E. �i ,1J�0^ � "V_e CITYISTATEIZIP: �G}G( Y�r� q,-7,03 <br /> PHONE(1): CCVU)LV(o -nyI PHONE(2): FAX ORE-MAIL: Nlc a r�.b.tv ( �rrra[tr+l. <br /> Please allow 10 business days from date of application submittal for the records to be available. (A 7-01 <br /> Staff will contact you to arran an a ointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT 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(209)464-0138,mail to the <br /> address indicated below,or email to info(asicehd,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:OOPM(EXCLUDING HOLIDAYS) S <br /> Electronic information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS 1N5 -r <br /> HEALTH DEPARTMENT <br /> FILES (Specifrc addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Streel# Street Name City <br /> Cleanup Site(LOP) '\)oU 51 ep/5 C]C9Nsurn <br /> 1 <br /> Other Cleanup Site(Non-LOP) ' Z , F+A'-ffr1 )'WEVI AjG0 <br /> ❑Hazardous Waste Fif'tUl� �tP �A5z- PieoS�zAaq <br /> Tered Permitted Facility 2 Ib33 C. r�� �C Vw� y.L a <br /> I V .1 t 'PI <br /> Aboveground Tank �r ' <br /> UST {Monitoring 1 Removal) �MrH11"t.ih7` 0�'I- 'P/ c)L-31Z <br /> Hazardous Materials 3 1]'73,5- S(.ttr Av—ui v-p— '40d'_�A <br /> Spill I Release Response n <br /> 115w uu L p ps,4 i �7A w.T ,wa coc <br /> Solid Waste Facilty I Uehid q y f uyi o� Ry-a+ Lk hA !f <br /> E]Food Facility J 11A f}p + rre <br /> ®Pool 1 spa t'`7�r 5 �h �r i� 615(�i SMmoanori <br /> ®Dairy 5 y0D S. ,VVI)Y-A- A-I r'-tt.k "PAa"4"2�a N4 w <br /> Land Use Application Sites j <br /> F1 Septic Pumper Truck 1 LA-/-7 0 y0 <br /> (v'�S- �. fCc I~ fYD(,ItYL <br /> Yard 1 Chemical Toilets ,QUi/IPr'A. � <br /> l�rf wastewater Treatment Plant uPA <br /> �❑Housing Abatement T ASTIHM/HW <br /> El MatelfHolef <br /> Chicken Ranch I Dog Kennel CUPA <br /> B UST <br /> gKiedical waste Facility <br /> n TattoolBody Piercing rOOLIDWASTE <br /> ❑Waste Tire g <br /> El Complaint <br /> ❑Other(Please specify): t]Accc UNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> ADA I,.-.:, ,'hi' 'L'cC�,. .f l� ,'�.)' a4 "�� Ftlti�, 7r� %1' <br /> A t <br /> Records provided by Staff-PPR Complete. staff Name: EHD 40-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.ccm <br />