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E-RECEIVEDM No. 0264 P. 1/1 <br /> 11 11 DATE REC51VED 0 EHD LOG NUMBER <br /> APR O b 201 1 SAN IOAQUIN COUNTY <br /> r L�'lo ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-8232 (vim <br /> EhWRONK*�NITALHmTii Telephone:(209)468-3420 Fax: (209)464.0138 Web:www.sjgov.org/ehd <br /> PER MiT/SEf;;U MS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: CiL�e.a /tunse.bl BUSINESS/AGENCY: C—aA.5 %AL,:rvtJML!4- 1 3:n(. <br /> ADDRESS: 153 jj S^1-rr__ee.I _ CITY/STATEIZIP: "Awe- !CA 01kSY l <br /> PHONE(1): (jjtD)2_4} jgSS' e,44a.31i PHONE(2):($10) 10 —''6$9 FAX OR E-MAIL: f eres, bit <br /> Please allow 10 business days from date of application submittal for the records to be avai able. <br /> ,/ Staff will contact you to arrange an appointment date and time to review the requested records, <br /> ['t/CHECK BOX TO IEXPEDI $ 3/�FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ { / DATE_ t{ I f <br /> 1. List up to ten addresses in the spate 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 mail 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 5139 deposit prior to review- �3 <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 Data Range of Information Requested: From _ M40 to 7-013' �- <br /> ENVIRONMENTAL � j U%�.� �, y, y—)-7 <br /> HEALTH DEPARTMENT FILE ADDRESS - EHD USE ONLY <br /> VNDERiRODND TANK(LIST) Street# Street N me city <br /> CLEANUP SITE(LOP) ' WW We{]I .YWt" ( ��dQ„ GOD j :I9-T— ❑CgNeVMER <br /> OTHER CLEANUP SITE(NON-LOP) 4J � N'n ^�0 I� <br /> �[�eREDP�DOu6wAETE „nt W' if ❑Daar <br /> F133EO PERMITTED FACILRV z 0 sA rr) �o �o n10� <br /> AISOVEcROUND TANKST (MONITORING/REMwAL) []PWS <br /> ll�'HAWtOOUS MATERIALS S <br /> ZBPILLIRELEASE RESPONSE <br /> L..1 SOLID WA EFAGLITV/VEHICLE 4 WATER QWLRY <br /> FOOD FACILITY <br /> POOL/SPA SITE MmwnoN <br /> DAIRY E <br /> Q LAND USE APPIICRTION SI}ES <br /> SEPTIC PUMPER TRUCK <br /> 6 <br /> YARD/CHEMICAL TDILETB <br /> ❑WASTEWATER TREATMENT PLANT <br /> CUPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTEL/HOTEL <br /> E]CHICKEN!RANCH/DDG KENNEL <br /> CUPA-UST <br /> ❑MEDICAL WASTE FACILITY S <br /> E]TATTOO/BODY PIERCING <br /> ❑WAsm TIRE CJ 8C4D W.sT[ <br /> H <br /> COMPLAINT <br /> OTKER(PLEASE SPECIP* <br /> ❑ACCOLINnNO <br /> 1E <br /> —BOXED AREA-END USE ONLY”' <br /> 14-7- Vi : LA once 1kLR°` Al & roe eI <br /> Z 1 T <br /> 0 Records provided by Staff-PPR Complete. s1AIIN6me: — �(, _ <br /> Received Time Apr. 7. 2017 2: 19PM No. 1210 <br />