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RECEIVED <br /> SAN JOAQM6 2018 Environmental Health Department <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EWRONiIAEWAL MIM �/ 03 <br /> PEW!171S SUBMIT BY EMAIL y)0 <br /> _ y� EHD LOG NUMBER: VV VVVV 111 <br /> APPLICANT: f 1DVA BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATEIZIP: <br /> PHONE(1): .py-9/ — PHONE(2):_ FAX OR E-MAIL. !0/K <br /> Please a ow 10 bust ss s from date of application submittal for the records to be available. <br /> Staff will contact yo to a n n ppointment date and time to review the requeste reco ds. <br /> SIGNATURE OF APPLICANT DATE L� <br /> 1. List up to ten addresses in the s ace below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to Info®sicehd coon 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 flies 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$162 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS - <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ndergmund Tank(UST) 9lreet 0Street Name City <br /> Cleanup Site <br /> Other Cleanup Sit.(No -LOP) t l/ewr <br /> o e <br /> ❑Hazardous Waste ` -..--_ ... <br /> F1 Tiered Pemnled Facility g 1301 W Osnr <br /> E]Abuiegiound Tank L/ <br /> OUST (Monllwing!Removal) N m I // `I' `I�,h� 0Pws <br /> Hemrdoua Matedeb t/t� J� G <br /> ❑Spill/Release Response ,�t <br /> Solid Waste Facility/Vehicle e W Tv/ Y ❑INATte puum <br /> Food Facility - <br /> Pool/Spa C tit r Jw V1– 7 D' ❑on Mrrannav <br /> El Dairy S �r V JV/�� rr�/vJ <br /> ❑Land Use Application Sites <br /> ❑Septic Pumper Truck I a7 T1 I ❑HouWva <br /> Vard 1 Chemical Toilets 7 /N1A/ <br /> ❑Wastewater to a nt Plant e w a o b E COPA <br /> ❑Housing Abatement 7 S ,t/ �1� <br /> AST/MMIHW <br /> ❑MotegHdel <br /> ❑Chicken Rench!Dag Kennel J/l�� N ' ❑CUPA <br /> Medical Weab Facility a (/-T UST <br /> Tettoo/6ody Planning --- +, <br /> I1 Waste The a Dacia Wae1F <br /> ❑Complaint <br /> EJ Omer(Please$perry): <br /> is D Accounrmo <br /> *"BOXED AREA-EHD USE ONLY"' <br /> e YC -� w <br /> �O <br /> Cil Records provided by Staff-PPR Complete. arm x.m.: An Mee EHa aa-0S <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.Sicehd.com <br />