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Q��'_ �A gR�� •� Ruses <br /> DAT RgCE1hEp-4��Y <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> )nn6yy ENVIRONMENTAL HEALTH DEPARTMENT <br /> �Cu E 1:(2 East Hazelton Avenue, Stockton, CA b:wW 6232 Q q(`TJJ <br /> LN��C. T;�i�E7AL��� Telephone:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/ehd V (6 <br /> f'ERA�JT = ;;Q PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. J C-'1� S/N G h BUSINESS/AGENCY: QUICK TRUCK REPAIR, INC <br /> ADDRESS: 19 E MINER AVE CITY/STATE/ZIP: STOCKTON, CA 95205 <br /> PHONE(1): -209,947-921-0-_ PHONE(2): S S 7- 08 g FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be aval able � <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE RE VEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10/19/16 <br /> 1. List uo to ten addresses in the s cel ow. 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 1209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted.Applications received aver 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$139 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 to <br /> ENVIRONMENTAL _ <br /> HEALTH DEPARTMENT FILE ADDRESS 4-Co For- Uf,S 1� p-)q <br /> •y� FILES EHD USE ONLY <br /> 1/L UNOERGRIXINO TANK(UST) street i Street Name city <br /> Yom' <br /> CLEANUPSITE(LOP) !. ''J <br /> ' h (� / Z CgNSUMEP ) <br /> ,,.O������THER CLEANUP SITE(NON-LOP 1950 EMINER AVE STOCKTON <br /> `� OOUS PERMITTED <br /> 1 <br /> TIERED PERMITTED FACILITY j <br /> 15§A80VEGR0UND TANK <br /> UST(MONITORING/REMOVAL) pWS <br /> ®HAUADONS MATERIALS 3 <br /> SPILI/RELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 DUWATER ALITY <br /> ❑FOOD FACILITY <br /> POOL/BPA $ISE MITIGATION <br /> DNRY 8 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑HOUgNG <br /> 8 <br /> VMD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PIANT <br /> CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTEUHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL fA1PA-UST <br /> ❑MEDICAL WASTE FACILITY e <br /> 0 TATTOO/BODY PIERCING <br /> WASTE TIRE 1a.WASTE <br /> 8 <br /> r7DCOMPLAINT <br /> ��•• OTHER(PLEASE SFELIFY): <br /> AIX.'WMING <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY— <br /> 19 ivr n Fi c3 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4806 <br />