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RECEIVED RUSH <br />DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />JEAN I G 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />MAR{Nvi& fREALft <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 15 <br />0�?q 2' <br />PENAIFT/SE PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: I/1' ' I- L BUSINESS/AGENCY: <br />ADDRESS: ✓o.4f 4 r.,... W411 CITY/STATE/ZIP: <br />PHONE (1): QQ - YIS-6m�_ 3 PHONE (2): FAX OR E-MAIL: & 4 j/4 f�+(4j <br />-Please allow 10 business days from date of application submittal for the records to be available. <br />Staff <br />will contact you to arrange an appointment date and time to review the requested records. <br />ECK BOX TO EXPEDITE REQUEST - $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIG OF APPLICANT DATE <br />1. List ua to ten addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <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 5:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map - Description: <br />Specific Date Range of Information Requested: From to <br />-PM <br />._/% <br />ENVIRONMENTAL <br />� 6 I It " 1 <br />HEALTH DEPARTMENT <br />FILE ADDRESSFILES <br />EHD USE ONLY' <br />�j <br />{- v <br />UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -L <br />0 ,: <br />1 <br />/ r � tc `6 <br />�!'Y'�` K d <br />1� A n <br />�,( r <br />7 <br />� % ❑ CGNSUMeR <br />, L v^, 'n, _ „ I ^ <br />)rJ /VAS'-JIF�'IN,V �, /vAl�/1 <br />HAZARDOUS WASTE <br />❑ TIERED PERMITTED FACILITY <br />J <br />o <br />t ]' G f/ <br />Fi 4V <br />J "•n <br />❑DAIRY <br />.� <br />ABOVEGROUND TANK <br />6 <br />) -, Q- <br />❑ PWS <br />j�UST (MONITORING I REMOVAL)�7 <br />HAZARDOUS MATERIALS - <br />)V G (0 N <br />171 -*k <br />r Ir <br />k 4( i /• <br />r (� <br />SISPILL/RELEASE RESPONSE <br />SOLID WASTE FACILITY / VEIL* <br />M <br />y�J✓�' <br />WATER QUALITY <br />❑ FOOD FACILITY <br />❑ POOL / SPAM <br />DAIRY <br />�v <br />G /,( {.,� <br />M _ ( Ih MmGAnoN <br />41y, t <br />❑LAND USE APPLICATION SITES <br />! <br />J <br />�]�7 <br />6 I { { O <br />PcrF �r w{ c( OF.- <br />ra <br />❑HOUSING <br />❑ SEPTIC PUMPER TRUCK/yea'"�" <br />YARD I CHEMICAL TOILETS <br />❑ WASTEWATER TREATMENT PLANT <br />El HOUSING ABATEMEN <br />515 i <br />T <br />S /t <br />9Sao6 <br />CUPA <br />❑MorEUFIorEL <br />lei'1 / <br />❑ CHICKEN RANCH / DOG KENNEL <br />❑ MEDICAL WASTE FACILITY <br />/� <br />/A <br />D( <br />G �[ n ✓^ <br />\ /� /,{nom/ <br />CUPA - UST <br />1y^� ✓ <br />l L W% / <br />E]TATTOO/BOOY PIERCING <br />❑WASTE TIRE <br />COMPLAINT <br />,� �--- <br />(j.V t� <br />i' f <br />8 ( <br />11 <br />/ � �• <br />(I�^ <br />L / <br />�G � <br />✓✓✓777 """ <br />1] SOLID WASTE <br />{y�/I''t (� <br />/C <br />❑ <br />D( <br />'�{/��►/�.y� //'�'^/ <br />I I �i `�'l p/ � A/ 1. 1 l.'� J <br />❑ OTHER(PLEASE SPECIFY): <br />�ryS� <br />S Grab <br />Ac o60 <br />t� i� o <br />—BOXED AREA - END USE ONLY— <br />EHD 48-06 1/'q n{' f Y `." . �Qe, (�dm �1Iab1I <br />�� ��J(11,,�,,4''�V t: `I •;/-� � fs�C� r,; cr1y11�I �t15 ,I. �1� 1 v /� /�' <br />6 I `5 ( 41 r �^_k i�"�/�/ r' I 1� IC{.1 �� #- 7J b � � i N' 1 `l l r� w `+L )-N�� o r x,000 " (Pr, . <br />; iJ� H 416P F YI�r �l �a5�1 z� z 000 <br />