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RECEIVED RUSH EHD LOG NUMBER <br /> JAR RUSH <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT / 505 CfYVIRONAENiAL f!¢Af-'�}I 1868 East Hazelton Avenue, Stockton, CA 95205.6232PEIWIT/SERWCE� Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ABUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: roti" 6 <br /> PHONE(1): Oj °//j- 7 PHONE(2): FAX OR E-MAIL: - r <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 requested records. <br /> CHECK BOX TO EXPEDITE RE EB $139 FE (CASH OR HE (ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNAA URE OF APPLICANT -P DATE / —J�Z <br /> 1. List up to ten, in th a below. Select the lyp (s)of files from the list below by check)g the appropr late <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 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> M,UNDERcaouNO TANK(USTJ Street# Street Name City <br /> • /CLEPNUP SITE <br /> (LOP) ��.q /�rd _ CONSUMFP <br /> 1 1 n l 6( n ('r/ <br /> EYOTHER CLEANUP SITE(NON-LOP) N E <br /> Y" M—R000S WASTE �1 <br /> TIERED PERMITTED FACILITY ❑DAIRY <br /> ABOVEGROUNO TANK <br /> ST (MONITORING/REMOVAL) V // /� <br /> 17SE DOUS MATERIAL$ J/ K(U <br /> PILURELEARE SPONSEG' <br /> Soup WASTE FACILITY/VEHICLE d L n ///f ] ' <br /> WATER OWLITY <br /> ❑FOOD FACILITY I dSoS V' ra //N 3 1v��– <br /> L <br /> ❑POOL I SPA SI;MITIGATON <br /> ❑DAIRY 5 \ <br /> ❑LAND USE APPLICATION SITESL <br /> P/17L/�4Ae„ . <br /> ❑SEPTIC PUMPER TRUCK/ 'll HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PUNT CUPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTEUHOTEL / <br /> ❑CHICKEN RANCN/DOG KENNEL <br /> ®CUPA-UST <br /> ❑MEDICAL WASTE FACILITY 0 <br /> ❑TATTOO/a00Y PIERCING <br /> ❑WASTE TIRE ❑SOLID WASTE <br /> 0GOMPLAINT 9 <br /> -❑OTHER(PLEASE SPECIFY)L <br /> ACCOUNTING <br /> 10 <br /> –BOXED AREA-EHD USE ONLY^ <br /> • <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> END 46-06 <br />