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RECEIVED <br /> aUlp <br /> SaN�JOAQUIN MAR zs 101 Environmental Health Department <br /> —COUNTY— PUIFLIC RECORDS RELEASE APPLICATION <br /> • cq`/ ¢ Greatness grows he SAL <br /> PFFF E= 2/21 EHD LOG NUMBER:la(bzcm <br /> APPLICANT: Jol-rn ktnntc(y BUSINESS/AGENCY: Hv1I +19Sioc-1 c.ICJ <br /> ADDRESS: N 4eml,ip)iere ImAs4 CITY/STATEIZIP: BeeJQo,,j 0 0 4) Litt, <br /> PHONE(1): 4yo-232--94e/5' PHONE(2): FAX OR E-MAIL: ILenne Jy @Im.11 tn�,com <br /> Please allow 10 business days from date of application submittal for the records to be available, <br /> Staff will contact lou to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT c.�0 L-- L DATE 312rblig <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the types)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,mall to the <br /> address Indicated below,or email to infoPsicehd.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. y�� <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From 64,.111Jf- awl l le to lm avch 7-81ZO(B <br /> ENVIRONMENTAL FILE ADDRESS N5n CV. ) 3.2$ <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ,xl�, {� AIO f ❑Coxsuaen <br /> Other Cleanup Site(Non-LOP) 1 13q0 O-r"—n+ LOr�'#' N• • ` 'GnAY" n <br /> • Hazardous Waste P 0 335 t <br /> Tiered Permitted Facility 2 I$0e� SPrec,KleS Blvd- (A L/lli--�eCC% Uh�' <br /> Aboveground Tank '''bT SM W N'v✓ It1 <br /> UST (Monitoring/Removal) PWS <br /> Hazardous Materiels 3 <br /> �5 spill/Release Response ATFAouunr <br /> rJ Solid Waste Facility/Vehicle <br /> ❑Food Faclllty <br /> ❑Pool/Spa ane MmonnoN <br /> ❑Dalry 5 <br /> Land Use AppllcaGon Sites HOUSING <br /> ❑Septic Truck uck/ 13 <br /> fi <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant VECUPA <br /> ❑Housing Abatement 7 ASTIHM/HW <br /> ❑MOtepHutel <br /> F-1ChickenRanch/Dog Kennel CUPA <br /> 6 UST <br /> ❑Medical Waste Facility <br /> ❑� Tedoolaody Piercing <br /> WT Seuo Wasre <br /> Waste Tire e <br /> ❑Complaint <br /> ❑Other(Please Specify): 0 Accou"Na <br /> 10 <br /> *"`BOXED AREA-EHD NSE ONLY— <br /> 0 - 4- rou: <br /> ❑ Records provided by Staff-PPR Complete.staff name: eHo ae-0a <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wv✓•r/.sjcehd.com <br />