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N asessm <br /> 1101811:38a PhlAesse is 916-988-6639 P.1 <br /> III <br /> RECEIVED d <br /> •: aPR � a ��IIR <br /> • SAN : J O A Q U IN EnVnronmental Health Department <br /> C O u ISI T Y EH P4mlHem:7}{ PUBLIC RECORDS RELEASE APPLICATION <br /> ,�L + 7� p �� SUBMm BY EMAIL EHD LOG NUMBER: 01b3jj <br /> APPLICANT: l/�I C� 1 A b J. /7OI BUSINESSIAGENCY: <br /> ADDRESS: .2-13 SA A- i X4-1 15 .1 %� 1 �. �� CITYlSTATEIZIP: <br /> PHONE(1): `` 7 i ..L j 2 PHONE(2): FAX OR E-MAIL: IL, <br /> Please allow 1U business days from date of application submittal for the records to beavailable. 11 SSjl h S <br /> Staff will contact you to arrange an in went date and time to review the requested r cord . !/ C6"IV <br /> SIGNATURE OF APPLICANT DATE —2c1 I )S <br /> 1. List un to ten addresses in the speare below. Address ra ILL NOT be accepted. Select the pals) of files from the <br /> list below by checking the appropriate box(es). At least one file UST be selected. Fax to(209)464-0136,mail to the <br /> address indicated below,or email to info(Osicehd.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 f�� <br /> Future file reviews by the same applicant may require a$152 deposit priorto review. L! <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 FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> f}�rUndeyround Task(LIST) Street# Street Name City <br /> Cleanup She(LOP) ❑Coaspusa <br /> Other Cleawp Ste(Non-L <br /> 17 A/, r3�IC1/+ sjZcx;c.� <br /> XHanrdous Wage Dvuar <br /> F1 Tiered Poll Facility 2 <br /> ❑Abovegmund Tank 1 1 <br /> ❑UST (Moniladng l Removal) PY✓5 <br /> 3 t <br /> E]Hazardous Materials d all 1A <br /> ❑Spill f Release Response WArea�.nurr <br /> Solid Waste Fac.lily/Vehicle e C <br /> ❑Food Faolity <br /> ❑Pool/Spa /` ✓� ) 0 SITE allDairy <br /> E .\��I7� Y rS <br /> 1 <br /> 0 Lend Use Application Sites <br /> Seal Pumper Truck I 0 Houswo <br /> 6 <br /> Yard I Chemical Toilele <br /> ❑wastewater Treatment Plant UPA <br /> ❑Housing Abatement T t / AI MOlellHolel (J r <br /> Chicken Ranch 1009 Kennel []CUPA <br /> B UST <br /> Medical Waste Facility <br /> TalloCueody R.n,,ng ❑S EUWAme <br /> Waste Tim B <br /> Complaint <br /> other(Please Specify): 0 ACCOUNTING <br /> ID <br /> r� —BOXED ARFA-EHD USE ONLY— <br /> t1-IO (V -G C ifre a4 M2 h4 e tt ✓✓1 <br /> • <br /> 0 Records provided by Staff-PPR Complete, start Name: ISHo esus <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br /> Received Tlme Apr. 10. 2018 11 :41AM No. 3353 <br />