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VEL <br /> D TAQP I <br /> SAN AJOAQUIN COUNTY EHD LOG NUMBER <br /> I�14 6 201b ENVIRONMENTAL HEALTH DEPARTMENT OqAa) <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> �NM �-AL (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> pERaAITPJEMACEO, 'EW PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: VV ALTER. "V L N BUSINESS/AGENCY: MNC_rL (;F—N V. <br /> ADDRESS: Z.Y:h 703(97 CITY/STATE/ZIP: S 2d7a <br /> PHONE(1): 547-835-5 8]k PHONE(2): " FAX OR E-MAJ L:U3qk'f eiach"r{cRAV, <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑,CHECK BOX TO EXPEDITE REOUE T-$139 F E,( SH OR-CHECK ONLY)-!REQUESTIPROCESSED IN 3'BUS ESS DAYS <br /> SIGNATURE OF APPLICANT \0 UW�.,W7 . DATE [O (/ I ca <br /> 1. List un to ten addresses in thetoce below. Select the type(s)of files from the list below by checking thle apl3ropriate <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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From !—L /AVAILACI-F—, to <br /> to <br /> !ENVIRONMENTAL <br /> HEALTH'DEPARTMENT FILE ADDRESS <br /> FILES 1 EHD USE ONLY ' <br /> UNDERGROUND TANK(LIST) Street# <br /> i IG StrLe`eet Naam�e/ City 114F O CONSUMER <br /> THER CLEACLEANUP SITE(LOP) IrC _9� <br /> C <br /> HAZARDOUS WASTE yl <br /> f <br /> TIERED PERMITTED FACILITY Z ^Jr\ ML �l, ��60VEGROUND TANK �ArLIST(cHms MATERIALS WAL) OPWSArpROOUS MATERIALS 3 <br /> XSPWJRELEA6E RESPONSE <br /> ❑SOLID WASTE FACILITY/VEHICLE A WATER OUAtm <br /> FOOD FACILRY <br /> POOL/SPA Sr_Mmwnon <br /> DAIRY S <br /> (]LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK 1 ❑H.,m <br /> 6 <br /> YARD/CHEMICAL TOILET$ <br /> I]WASTEWATER TREATMENT PLANT <br /> CUPA <br /> HOUSING ABATEMENT l <br /> ❑MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY 6 <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE ❑SGUO WASTE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPEC11Y): A.HRw <br /> 10 <br /> -[W%ED AREA.EHD USE ONLY^' <br /> M Z S T <br /> 16L20 44,^04c- <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 68-06 <br />