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ATEJKii6`6V.1VtLA e,. SAN JOAQUIN COUNTY No, 0584EHDP. 1VUMBER <br />ME: JAN 2 5 20118 t -2G ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL HEALTHeIQphone: (209) 488-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PERMIT/spPmrize PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: I57�r3 w" -.I &+- `t11S Ct( CITY/STATE/ZIP; <br />PHONE (1): 0,94 7-1 PHONE (2): q $-'-7J0•- 1?(y FAX ORE -MAIL: Ari Aur dal <br />Please allow 10 buslness 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 RE EST- $139 FEE (CASH OR CH K ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNAE OF APPLICANT DATE f —ag ICS <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 mall 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 9:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description:_ <br />Specific Date Range of Information Requested: From to - _ _ <br />ENVIRONMENTAL <br />4no tpZ.,cl cAcZii A Lh ML Ao Lon et% RZRr ala, I f r.. LI„ ' ", <br />v ' L z W -- <br />U <br />Received TimedJan.25.f201BE 9:45ANLNo.2936 <br />1 u,� ICD, �.Z,(p-I $ <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EF�D USE ONLY <br />FILES <br />F�YUNDERGROUND TANK (UST) <br />Street <br />Street Name <br />city <br />CLEANUP SITE (LOP) <br />/� <br />n <br />(yam <br />�,(�� t CONBIIHEP <br />CLEANUP SITE (NON -LOP) <br />JOTHER <br />RDOUS WASTE <br />�� LD <br />DMm <br />TIERED PERMITTED FACILInY <br />$ <br />L <br />90UE41iOUNo TANK <br />ry{yyST (MONITORING / REMOVAL) <br />❑ PWS <br />HAZARDOUS MATERIALS <br />9 <br />PILURELEASE RESPONSE <br />4 <br />WATER QUALITY <br />SOUD WASTE FACILRY / VEHICLE <br />PDOO FACIUTY <br />SITE 10 MCAT OW <br />❑ POOL / SPA <br />AIRY <br />S <br />ES <br />ALAND USE APPLICATION SMFS <br />SEPTIC PUMPER TRUCK / <br />❑ Houma <br />YARD! CHEMICAL TOILETS <br />e <br />IJy WASTEWATERTREATMENT PLANT <br />HOu91NO ARTEMA <br />T <br />`r <br />❑(� <br />MOTEUHOTEL <br />L_CUPA <br />I� Iry <br />CUPA - UST <br />CHICNPN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />0 <br />❑ TATroo/aODY PIERCING <br />SOLID WASTE <br />WASTE TIRE <br />�CAMPWNT <br />B <br />❑ OTHER(PLEASE SPECIFY): <br />Accou"Re <br />10 <br />"'e0%ED AREA - EHD U0E ONLV^' <br />f -)T iTp - (NI lei <br />4no tpZ.,cl cAcZii A Lh ML Ao Lon et% RZRr ala, I f r.. LI„ ' ", <br />v ' L z W -- <br />U <br />Received TimedJan.25.f201BE 9:45ANLNo.2936 <br />EHD 40-06 <br />