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�r231701:42p Phase lAssessments 916-988-6639 p.1 <br /> RECEIVED' <br /> [,a <br /> ZO'r 1, �� EHD LOG NUMBER <br /> DATE RECE L n� <br /> 3 hl SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PEIRAMSERVICES Telephone:(209)468-3420 Fax:(209)4640136 Web:www.sigov.orgrehd <br /> rC ' <br /> A7 PUBLIC RECORDS RELEASE APPLICATION <br /> S14A' <br /> APPLICANT:[--A-he U A-9IW r 37 E , 13USINESSIAGENCY: <br /> ADDRESS: 2. 7-..3 �A"YVly AW1,L.0 � CITYISTATEIZIP:�L�'�/6� <br /> PHONE(1): Eo e — 2.-PHONE(2): FAX OR E-MAIL:Fb�ifk''��.(� <br /> Please allow 10 business days from date of application submittal for the records to be available.Ac;,;, S �> <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE RE _ OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS 7SIGNATURE OF APPLICANT DATE 3..rZ 3 SCJ,I <br /> 1. List up to ten addresses in the space below. Select tlie'typR�(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091-484-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after3:00 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 EHO 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 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: []List❑ Map—Description: <br /> Speck Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> FILES (�, ,• <br /> HEALTH DEPARTMENT FILE ADDRESS i6� SEP. ONLY <br /> ��( -y-, <br /> r�nJUNDERmounc TANK(UST) Street At Street Name city <br /> I lou p sRE(Lep) .-J�/J/.,A�. �n, N O 1 Cl GON9I:MER <br /> IYD 01H01DP SuE(NOWLOP) -r <br /> IYHA MOUS WAST_ /J U J 1 <br /> hhh❑hhhnnnnnn TIERED PERM:ITEO FACILITY ] I !j . If e)�[�rl�{r D[' �1 ^�^_f� <br /> IAIASOYEGRCUNO TANK rs �Y1 Y/ I-r / rl`•1/„ <br /> -�AUST(MONRORINC(REMOVAL, �j qqq V+�' ( NOW <br /> LID 1No I]Pv <br /> ❑ RDOUS MATERu:S I ^('®� 1V <br /> ❑SRLLIRELE0.4E RESPONSE I WATEP DVAL� <br /> ❑SOLID WASTE FACIIa1Y I VCNIGE d <br /> ❑FOOD FACT <br /> ❑POOL I SPA S1E MRNATpp <br /> ❑0. G <br /> ❑Lu1O USE APF MCN STES <br /> Ham.❑SEPTIC PUMPER TRACK I ❑ <br /> 8 <br /> YsnO f CM£Mlcx ToxETs <br /> ❑WA WATEn TREATMENT P T JA GM <br /> ❑HOuSNG ABATEMENT 1 r <br /> ❑MOMLIHOTEL <br /> ❑CHICKEN RANCH I DOG KENNEL .PA-UST <br /> ❑AIMMAL W.L FACCEW a <br /> ❑TATRIOIRDOY PIERCMG <br /> $ODD WAsiE <br /> ❑W4STE TIRE <br /> 9 <br /> ❑COMPW VT <br /> ❑OTHER(KEASE SPECIFYI: Q A®ON9NG <br /> 10 <br /> BOXED AREA-EHD USE ONLY"' <br /> ❑Records provided by Staff-PPR Complete. slae NVRe: <br /> EHD 446 <br /> Received Time Mar. 23. 2017 1 :40PM No, 1092 <br />