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DATE AF-MM16-1 R EHD LOG NUMBER <br /> 20%5EP Z 2 �� SAN �oAc�ucl� COUNTYNViR{?NNIENT'AL HEALTH DERARTMEMT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> E"R0NJr,r-NTALHMT1fephone: (209) 468-3420 Fax: (209)464-0138\ffeb:to+ww.sjgov.org/ehd <br /> PERMiTISERMCES PUBLIC RECORDS RELEASE APDL ICAT>01%1 <br /> APPLICANT: new\ BUSINESS/AGENCY: <br /> ADDRESS: 7 5 jV• c,, L.-l1, .�f . CITYISTA.TE/Z!P: UG -kryl � <br /> I,H0H[Z- ('i): PHONE (2): FAX" OR E-F4 AUL: <br /> Pieaae allovv','u busines8 da}'8 from date ui application submittal for the records to be akraiianle. <br /> Staff wHI corftact you to arrange an appointment date and time to reVieW the requested records, <br /> ❑ CHECK BOX TO EXPEDITE R QUEST (CASH OR CHECK ONLY)-REQUEST FROCESSED IN 3 B SiNESS DAY <br /> vi GNI F-,TURE OF APP l i.ENT <• <br /> t�:t<ri ATURE r.r:LtCr-:t t _ C1fk f E <br /> 1. List up to ten addresses in -,res below0ect . <br /> el ct the type(s) of files from the list below by checkin the appropriate <br /> box(es). At least one file type h4 ST be sFax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges xvill not be accepted. Applicationsafter 3:00 pm will be processed the next business day2. For assistance in identifying the mature ant 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 revfevr will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business drays for revievtr. Appointments <br /> should be scheduled accordingly. <br /> 4. Knv fiie not returned in the same condition as reieasod will be reorganized by EHE staff at the expense of the applicant. <br /> Future rife reviews by the same applicant may require a $139 deposit prior to review'. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-MDAY MO AN:-5MPAt (EXCLUDING HOLIDAYS) <br /> Electro nig fnfGrrna%on� ❑ List ❑ itFiap— Description: <br /> Specific Bate Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEAL THDEPARIMIENT <br /> FILES s cele rZEr�e« La EHD .'5E a-4-LC€ <br /> UNDERGROUND TANK(UST) Street 9 .Street Name City <br /> CLEANUP SITE(LOP) j CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) I /t�gg5 <br /> L_I 11A-7A rMASTE ! (J Y✓ l 1. "UY''� l <br /> ��ff' � " Q DAIRY <br /> TIERED PER. FACILITY 2 V <br /> ABOVEGROUND TANK <br /> Gi UST (MONETORINC r REMOVAL) I D PWS <br /> 3 <br /> r� <br /> HAZARDOUS MATERIALS <br /> SPILVRELEASE R=SPONSE <br /> l] <br /> SOLI MASTS FACILITY 1 VEHICLE 4 WATER QUALITY <br /> Ooo FACILTTY <br /> POOL 1 SPA ❑SITE MITIGATION <br /> DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 6 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> I]WA=VVATER TREATMENT PLANT (T CUPA <br /> ❑HOUSING ABATEmFNT 7 y <br /> MOTEL/HOTEL <br /> CHICKEN rRP.NcH/Doc KENNEL �]CUPA-UST <br /> 8 <br /> F-�MEDICAL WASTE FACILITY <br /> TAT7oo/BODY PIERCING <br /> SOun WASTE <br /> WASTE TIRE 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ID ACCOUNTING <br /> 1D <br /> i `•`BOXED AREA-EHD USE ONLY"' <br /> LRs provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />