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.ECEIVEt) <br />DATE RECEIVED RUSH EHD LOG NUMBER <br />C3 <br />JAN I 2017 SAN .IOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Eflfili{NlidE�e fAL FI.T 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 15�?92- <br />PER MKAS)lE+ PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: VI' I-Ve-BUSINESS/AGENCY: <br />ADDRESS: t✓ CITY/STATE2IP: <br />PHONE (1): - Y Y/,y— L3 PHONE (2): FAX OR E-MAIL; <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 />CK BOX TO EXPEDITE REQUEST - $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIG OF APPLICANT DATE <br />1. List up 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 END 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 />I�(3 <br />I�aP <br />ENVIRONMENTAL <br />S' cc, <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY" - <br />FILES <br />UNDERGROUND TANK (UST) iV <br />Street # <br />Street Name <br />City <br />CLEANUP SITE (LOP)/CONSUMER <br />OTHER CLEANUP SITE <br />IC) (NON -L <br />\ <br />1 915(,� <br />i <br />1 1 f <br />/' "' �� <br />(•/[_`/n C \ / <br />V y-)� / Ai✓.1/1/( (',{� <br />HAZARDOUS WASTE <br />E <br />TIERED PERMITTED FACILITY <br />r'I <br />0 DARY <br />QA60VEGROUND TANK <br />% -. it <br />PWS <br />II UST (MONITORING (REMOVAL) <br />HAZARDOUS MATERIALS <br />jA(j <br />( /� r �/ <br />7 <br />SPILURELEASE RESPONSE <br />SOLID WASTE FACILITY / VEryylp, <br />/ (L Il f in <br />�'W `""- ` <br />WATER DUALITY <br />E] FOOD FACILITY <br />�( JV <br />�� i f`_"' <br />❑ POOL / SPAG <br />F-1 DAIRY <br />T <br />�[ h� <br />JI7i r� �/ <br />_ M I _ I iTEfITIGATION <br />LA <br />✓jy,/�� <br />LAND USE APPLICATION SITES <br />(/�/ <br />6 <br />_! O <br />� ,q10 <br />iy4 <br />-, <br />HOUSING <br />E] SEPTIC PUMPER TRUCK / <br />YARD /CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />1 {{{ <br />k <br />CUPA <br />HOUSING AOATEMENT <br />MOTELMOTEL <br />/J <br />W <br />T/ <br />CHICKEN RANCH / DOG KENNEL2 <br />MEDICAL WASTE FACILITY <br />S J�O <br />nG <br />Pe,���✓''t G /( <br />� -I y, r <br />CUPA • UST <br />1Y' �' "'y� •,.�/{'j/� /P <br />�" / <br />TATTOOBODY PIERCING <br />WASTE TIRE <br />h <br />Y,TYI <br />" <br />9 r <br />r <br />/ <br />(W/� � <br />�j I <br />LM (��/� <br />✓1 <br />SOLID WASTE <br />VI <br />✓%��/ <br />FICOMPLAINT <br />� <br />D� <br />��/PIC.i�L1�t�i <br />� I "0 <br />OTHER(PLEASE SPECIFY): <br />ACCOUNTI <br />-BOXED AREA - EHD USE ONLY— <br />�-1 � � ��/�' �i • .� � � � ! �+�� rte..•. .r ,e_��� �' G <br />� J � � - ii'%i� !lll�� / aL i Lii1Cs�• !!9 iiTi��./ ��� <br />EHD 46-06 I i q (of <br />ti ( ((Vji el I • f� (-C rkze J� N-11 n5��'(�'�%f. �it< Lll fl dpi 4 I�i I t /J'"�! i jolt-4- <br />615t <br />am' i - <br />5 5t At r4 � �;� � wW�b��i3� �c�� 5 ,) 4J -,D- <br />; iJo H:41 PF(�F�i JS�izyz<cx�� gifPo�t-�tknMB�r��, �P( �bzp <br />