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RECEIVED <br /> SAN,;JOAQUIN hiAR 16 2018 Environmental Health Department <br /> _=11 —COU NTY-- PUBLIC RECORDS RELEASE APPLICATION <br /> t,✓ EWROMMEWALHI W <br /> PIe �l /Vi !, <br /> PlMITI$ EMAIL �J `}/�j <br /> EHD LOG NUMBBER: 0 n2 <br /> APPLICANT: O �}('t� SMt-�-h BUSINESS/AGENCY: �Arf� �AaaUty1 [� 1 Q <br /> ADDRESS: ���b!e SAi'-e_e CITY/STATE/ZIP: g{r•G C�S'7 nb <br /> PHONE(1): 2 — '}— b(p PHONE(2): Q16—!-,"l�$-3'Lg(� FAX OR E-MAIL: � ,mli � Sal,� _`. <br /> Please allow 10 business days from date of application submittal for the records to be available. c LOM <br /> Staff will contact youge an polntment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT I= DATE at /15/( /Q <br /> 1. List up to ten addresses In the s e w. dd ess ranges WILL NOT be accepted, Select the types of filefs from the <br /> list below by checking the appropriate od(es). At least one file type MUST be selected. Fax to(2091464-0138,mail to the <br /> address indicated below,or email to info(dsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 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 / 13 1, to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( Ponly, 8 p <br /> FILES 5 eciFlc addresses address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ^`,I�t4 LL_, r'(� ♦ y r.��n ❑care.. <br /> ❑Other Cleanup Site(Non-LOP) - <br /> ❑Hazardous Waste 13 DAIRY <br /> Tiaretl Pennittetl Facility T <br /> Aboveground Tank <br /> UST (Monrm <br /> ng/Rooval) E]PWS <br /> n Hazardous Materials a D <br /> Spill/Release Response <br /> Solid Waste Facllity/Vehicle 4 ❑WATER Duauty <br /> ❑Food Facility <br /> ❑Pool/Spa ❑sta Mn44TION <br /> F-1 Dairy 6 <br /> F-1 Land Use Application Sties <br /> Septic Pumper Truck/ L]Houma <br /> 6 <br /> Yard!/Chemical Toilets <br /> Wastewater Treatment Plant ❑CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> El Motsim-lel <br /> 71 Chicken Ranch 1 Dog Kennel ❑CUPA <br /> Medical Waste Facility 6 UST <br /> ❑Tattao/BDdy Piercing <br /> ❑Souo watt[ <br /> Waste Tire 9 <br /> ❑Complaint <br /> ❑Other(Please Specify): ❑ACCOi <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> clo - I ks o 2 ri <br /> a s <br /> Records provided by Staff-PPR Complete. staff Name: eHD 4R 06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />