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REC <br /> T I d E - I� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 6 <br /> b 2 ENVIRONMENTAL HEALTH DEPARTM t w� <br /> 1668 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> °'d6RGfdCe1LM f ATL -- .( Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd ��iIIfFF <br /> P A(TISERVICES PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICANT:_ �(�rr. 4i_il BUSINESSIAGENCY: Z ANCg& C 1�7E Lt- aOu'fl <br /> ADDRESS: Lf-/7;r� �1/lJk' K /F,`-Ct I Pi'G 7 t l D CITYISTATEIZIP: SJ f r[A <br /> PHONE(1): (�--(�-�C S ��Lf-f PHONE(2):�'� -(�0�� FAX OR E-MAIL: Tom- �, { e,L^ _�..,fp,•.L <br /> Please allow —o business days from date of app)cation submittal for the records to oe avdilable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> E,CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS p <br /> SIGNATURE OF APPLICANT MA A to Y r-V DATE 0 5- ?U 12-0 1.4 <br /> 1. List uo 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 ormail 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$130 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 /> Specific Date Range of Information Requested: From to ° <br /> ENVIRONMENTAL (4rjl <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> jl-rIUKOERGROUNO TANK(USTI Street# Street Name City <br /> r'�CLEANUP SUE(LOP) P9 <br /> MPrf,IPsft 2aaD spur rpN <br /> •t�OTHER CLEANUP SITE(NON-LOP) <br /> ��FT1i <br /> HAZARDOUS WASTE /.LL/ ^I� L�db Dully <br /> fjr!I TIERED PERMITTED FACILITY Z _/ I�' MS��I��"�•A. �� � ^�� !V <br /> �)AABOVEGROUND TANK �lT �r llO� YYYIII ___ CjPWS <br /> (qTy�, <br /> UST (MONRORING/REMOVAL) `� n (r'�^T <br /> MI HAZARDOUS MATERIALS ' ( 3 oC M I r OJn �•':/ �I L/ /V <br /> YI71-�SPILURELEASE RESPONSE ®WAUEI CUAUTY <br /> ❑SOLID WASTE FACILITY/VEH� y ���� <br /> FOOD FACILITY QQ <br /> �POOL I SPA <br /> (0 SITE MITIGATION mI" <br /> ]DAIRvAf-W)J-K OAD S-Mc -Miv o <br /> AQ Y <br /> LAND USE <br /> ON <br /> SEPTIC PUMPER TRVILK SITES /yy� P f/� ('('� to I.( � Go ,5 ,WMIHOUE.. <br /> ❑YARD/CHEMICAL TOILETS ° �'" M�II C'fA -AP _F'Mc`-Tv� g0 co/"/ �F' <br /> WASTEWATER TREATMENT PLANT tf'/_ a �/ ®CUPA <br /> j]HOUSING ABATEMENT T M41 <br /> / ©0MIS �O'AD <br /> Srry)/•{.�I/I IV "'" IW '?j <br /> �MOTEUHOTEL C li (rVV�L (✓JV n� I✓L_M1_i✓LY G ` SPA-HAZ-MAT <br /> L]CHICKEN RANCH I DOG KENNEL � U"/ Oz'J <br /> MYEW <br /> F ° PZ�ot S NwY q T <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING SOLID WASTE <br /> ❑WASTE TIRE B 'u <br /> ❑COMPLAINT <br /> lfe- <br /> OTNER(PLFASE SPECIFY): - 40 501 U3/mI�w!n <br /> 10 e, -A <br /> frn sa4 <br /> ***BOXED AREA-EHD USE ONLY*A <br /> g e a3 Sa nL4q fz2t i00 <br /> t F p Oz <br /> r ` I lIlm 51 W0IyL;rf1M in b ' 1 46 af: <br /> 1:3 RaccIvIds ptoviclad by Staff-PPR <br /> EHD 48-06 'YV�f, 'All F+ $ - aL{�4�ma-,0 -)PGI <br /> 243IA14 Qe5� <br />