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27 2017 08:59AM Enviro Assess 8776235493 page 1 <br /> RECEIVED t 4k I <br /> LTE RECEIVED SAN JOAQUIN COUNTY � 1EHD LOG NUMBER <br /> FEB 2 % 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 y\ <br /> @'WRONfI WAL hana: (209)468-3420 Fax; (209)464.0138 Web:www.sigomorg/ohd V <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS; CITY/STATE/ZIP:. <br /> PHONE(1): $ . .rt�-7�� PHONE (2p FAX ORE-MAIL: •+ �Li7Yl�e5:SP5S,�m <br /> Please allow 10 business days from date of application submittal for the records to be av al le. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> EV H( 14 T EialTE:EC�IJEs ¢ 1 Fl wt g cls iwa 4 <br /> SIGNATURE APPLICANT DATE I. v2F, <br /> 1, List up to':tn addresses in pace b . Select the type(s)of Flies from the list below by checking th` 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 clay", <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number npted above. <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately tan(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. A1ppointments <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 o}the applicant. <br /> Future file reviews by the same applicant may require a $139 deposit prior to review. 12 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 11:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List❑ Map-Description: <br /> Specific Date Range of Information Requested: From - to - <br /> EN ti)yC(j� 3 4 `'-T PT e-7. -I? <br /> ttEA >wj°axranEnt FILE ADDRESS EHD USIE ONLY <br /> F <br /> ' I UNDERGRUNOTANK(UST) street# Street Name city <br /> d CI EANUP SnE(LOP) ' U�- (Zf)Z 13Z ❑LONs MER <br /> OTHER CIEANUP SM(N y�wGf . <br /> I�(I HAZARDOUS WASTE ®uC ❑DNRI <br /> ❑T�TIPRm PERMITTED FACIL" 2 <br /> 1';ABCVEOP.OUND TANK 3�tP <br /> rr%UST(MONRORING/REMOVAL) P <br /> t✓✓I HAZPROWS MATERIALS S .. <br /> YIJ�I$ILVPaEA=E RESPONSEWA.O.Lrtv <br /> Sp.N WASTE FACIL"I VEHIME 4 <br /> FOOD FACEnr .L <br /> POOL 1 SPA Lj SNE NbncATION <br /> ❑DAIRY B <br /> LAND USE APPUCATON SnES <br /> ❑HOUSING <br /> SFPTC PUMPER TRUCK/ <br /> B <br /> VAPD/CHEMICALTOLEIS <br /> WABTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT T ` <br /> ❑MDTEUHOTEI- <br /> CHICKEN RANCH I DOG IrENNEI- CUPA-UST <br /> ❑MEVK:AL WASTE FACUW B <br /> I <br /> ❑TATTOOBODY PIERCING SOU,W. <br /> WASTETIRE :l <br /> 8 <br /> COMPU'N <br /> OTHER(PLEASE SPECIFY)' D AQ-a,vTNO <br /> 10 I <br /> —192ID AREA-EHD USE ONLY"' <br /> 5 <br /> 0 Records provided by Staff-PPR Complete. staff name: <br /> Rece-ived Time Feb. 27. 2017 10:01AM No. 0886 <br />