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3 / JMBER <br /> '7 <br /> NEO v SAN.IOAQUIN COUNTY IV 0. I I y EM r• <br /> =_NVIRONMENTAL HEALTH DEPARTM <br /> 8 201 _j8 East Hazelton Avenue, Stockton, CA 9520 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/ehd <br /> !ZENTlai..HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> \PPLI� =` BUSINESS/AGENCY:,_&W�I0"v/N cry pv,&-Wke� <br /> ADDRESS: /$/D �. 4f CITY/STATE/ZIP: A ( SAOs <br /> PHONE (1): T'C(3 L( PHONE(2): FAX OR E-MAIL: 209-q&& —.291'j <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 request r <br /> ______, ._ _ CRY <br /> ❑ CHECK BO)C TO DCPEDITE U__ST-$1,.�,� HECK ONLY -REQUEST PROCE$ Ep I 3 I SS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresse - space o . S ct t e pe(s) of files from the list below by checkinb thk appropriate <br /> box(es). At least one flle type MUStoselected. F t (2091464-0138 or mall to the address indicated above. Address <br /> ranges will not be accepted.Applications received afWr 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 Informatlon Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH.DEPARTM_ENT FILE ADDRESS <br /> - FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) .Street# Stroat Name City <br /> may{CLEANUP SITE(LOP) (je I.\�` �� CONSUMER jn <br /> Y I OTHER CLEANUP SITE(NON-LOP) 1 I rI, mQ, U�J <br /> /PJ'HAZARDOUS WASTE camo <br /> TIERED PERMITTED FACILITY z � ,r1 •! �� J � � <br /> UAIRY <br /> iABOVEGROUND TANK <br /> r� <br /> �CJST (MONrrORINGIREMOVAL) n Q,I y.yl [� L]PWS <br /> 16AZARDOUS MATERIALS 3 ' a W• (/y/ I Lam,S cxrKp <br /> .19'S'PILL/RELEASE RE8PON8E <br /> GVl C.h <br /> �SOLiD Wgg7E FACILITY/VEHICLE 4 WAT4R QUAurr//�y (� <br /> FOOD FACILITY <br /> POOL/SPA <br /> i' 317E MITIGATION <br /> DAIRY 6 j�l� '� (�Vfc,^ <br /> 1Ci7, <br /> LAND USE APPLICATION.4irEa <br /> SEPTIC PUMPER TRUCK/ L/ `_ 1 HOUSING <br /> WARD/CHEMICAL TOILETS B `� I m athew 5 /vrb,1 <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT A G-71 q CUPA <br /> Ej MOTEIHoTEL " <br /> CHICKEN RANCH/COG KENNEL CUPA-UST <br /> CALWASTE FAORITYOM7 OO/BODY PIERCING <br /> WASTE TIRE $OUo WAS' <br /> 9 <br /> COMPLAINT <br /> F�OTHER(PLEASE SPEci;,Y): <br /> ACCOUNTING <br /> 10 <br /> ""BOXED AREJ�.EMD USE ONL7"• <br /> Received Time oct, 18. 2016- 2; 35PM_No. 0180 <br /> EHD 4808 <br />