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RECEIVE <br />, q is RUGH <br />DATE RECEIVED I�J SAN ,JOAQUIN COUNTY EHD LOG NUMBER <br />JAN 16 2017 �,t ENVIRONMENTAL HEALTH DEPARTMENT /j <br />EtJV1RONMi 1SiAL,k p 1: (2 East Hazelton Avenue, Stockton, CA b: www,sjgov.org/ehd <br />Q 15 59 - / <br />'f ���� . ele hone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsjgov.orglehd `T/� fly <br />E PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: i/(' e-BUSI <br />_ NESSIAGENCY: <br />ADDRESS: 1A/ CITY/STATEIZIP: ?;Vb,.,u r,4 � � f' �� <br />PHONE (1): OQ - V — 3 PHONE (2): FAX OR E-MAIL: <br />,yulable. n le ? , <br />'H(ease allow 10 business days from date of application submittal for the records to be available. �. re><.-, <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />CK BOX TO EXPEDITE REQUEST- $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIG OF APPLICANT DATE <br />1. List uo to ten addresses in the space 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 1209) 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-5:00PM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL11(�I <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />FILES <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />Street 4 <br />Street Name <br />City <br />CLEANUP SITE (LDP) <br />LEAN <br />OTHER CGP SITE MON-LDP) <br />IJ <br />1gr)i <br />� I k <br />1 <br />-( CoxsuneR <br />ND 1,� t�orh <br />�HA DOUs WASTE <br />s� <br />Z <br />I / r% <br />« I O I l ! <br />�� ❑ �Nv <br />❑ TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />cow <br />EI UST(MONITORING/REMOVAL) <br />`T;1 HA] Gws MATERMLS - � <br />_- (j PWS <br />3 <br />V /i (% <br />,��- <br />d- <br />EkSPILUREULSE RESPONSE <br />/V,9 CO 54 <br />I <br />`^ Q /n <br />. 19—t- <br />t- •%J2 osl'7t WATE. Du." <br />❑ SOLID WASTE FACBUY / VEHICLE <br />r-1FOODFAGWTY <br />1 V <br />cole,O <br />❑ POOL / SPA <br />DAIRY <br />5 <br />10 <br />, �" <br />QQ1 - L <br />✓�L�II� <br />/� �/ Slte MmGAnox <br />U�-f-/J(�0�Z3 <br />U - pie <br />r] LAND USE APPLICATION SUES <br />J <br />to / <br />Pvti <br />1 <br />� <br />❑ SEPTIC PUMPER TRUCK/ <br />YARD/CHEMICAL TOUTS <br />B <br />)�qV <br />(r� Dic <br />p <br />HOUSING <br />W <br />❑ WASTEWATER TREATMEM PUNT <br />❑ HOUSING ABATEMENT <br />MOTELMOTEL <br />❑515 <br />rNwrCc <br />No cP(�P <br />I <br />S �'r &CJ <br />r.T N <br />j <br />ILJp U� t CUPA <br />W <br />06 <br />o CA <br />❑CHICKEN RANCH/DOG KENNEL <br />S <br />I ��O <br />PeY171,r,w� <br />��� <br />'V� �(� CUPA-UST <br />V <br />E]TATTOOMODY PIERCING <br />4 <br />D <br />I <br />I <br />I <br />,w^ , 9 <br />%t G�L <br />�'p '006 <br />. AG�> ❑ SWo WASTE <br />D- <br />D VU <br />❑ WASTE TIRES <br />❑COMPUMT <br />E]OTHER(PLE SPECIFY): <br />1B <br />(' <br />/ <br />Gla'O6 <br />P ❑A«O <br />w�'Kli ., <br />No <br />t � <br />�3�(��r <br />irylANIiNA A r ► 1. i <br />