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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT: -r—r.r.n�„� -1 rnw+i-e S BUSINESS/AGENCY: ADDRESS: Z CITY/STATE/ZIP: SoLr rc�tM 'd'� cIS�3S� PHONE (1): LCt 16 Li foss— 6 PHONE(2): FAX OR E-MAIL: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK BOX TO EXPEDITE�REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANTer�c L p Tq Kt-S DATE 1. List up to ten addresses in the space below. Select t types)of files from the list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$139 deposit prior to review. WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) Electronic Information: ❑ List ❑ Map—Description: Specific Date Range of Information Requested: From _ to ENVIRONMENTAL HEALTH DEPARTMENT FILE ADDRESS FILES EHD USE ONLY ❑UNDERGROUND TANK(UST) Street# Street Name City CLEANUP SHE(LOP) I]CONSUMER ❑OTHER CLEANUP SITE(NON-LOP) ❑HAZAROoUS WASTE 13 DAIRY ❑TIERED PERMITTED FACILITY 2 ❑ABOVEGROUND TANK ❑UST (MONITORING/REMOVAL) ❑PWS E]HALAROOUS MATERIALS 3 ❑SPRL/RELEA$E RESPONSE ❑SOLID WASTE FACILITY/VEHICLE 4 Up Fj ❑WATER QUALITY ❑FOOD FACILITY ❑POOL/SPA ❑SHE MIT NWHION ❑DAIRY 6 ❑LAND USE APPLICATION SITES SEPTIC PUMPER TRUCK/ 6 HOUSING YARD/CHEMICAL TOILETS WASTEWATER TREATMENT PLANT ,jS) L V_2ot+f�` y7 __( :5` ( _ L CUPA HOUSING ABATEMENT '/ L( �Q IW 1LC.f�T�` .(C'tC1 ❑MOTEL/HOTEL a/ •CVVtG� NN r-1 CHICKEN RANCH/DCG KENNEL ❑CUPA-UST 6 ❑MEDICAL WASTE FACILITY ❑TATTOO/BODY PIERCING SOLID WASTE ❑WASTE TIRE 9 COMPLAINT ❑OTHER(PLEASE SPECIFY)'. ❑A=OUNnNG 10 "'BOXED AREA-EHD USE ONLW" Z Records provided by Staff-PPR Complete. Sniff Name: EHD 46A6