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RECEIVED <br /> DATE RECEI D EHD LOG NUMBER <br /> " <br /> SAN JOAQUIN COUNTY <br /> f tb ��� <br /> ENVIRONMENTAL HEALTH DEPARTMENT!NMRONIMENTAL l-`�'IiTH 1868 East HazIton Avenue,Stockton, CA 95205-6232 <br /> ERMPfrP,fcSt!'?CM Telephone:(209)468-34 0 Fax:(209)464-0138 Web:www.sjgov.org/ehd 5000 <br /> M PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r� MCI w.: BUSINESSIAGENCY: �jr Lnef r 'h t'r r4 <br /> ADDRESS: t?T )_ 04 Sacre,wAtYA oA (� f1 SSI`j CITYISTATEIZIP: <br /> PHONE(1): g164o5 -12.15 PHON (2�$..'36S FAX ORE-MAIL: jrytAr '.n; Mr'tntrts:,tow. <br /> Please allow 10 business days from ate of application submittal for the records to be available. <br /> Staff will contact you to arrange an ppointment date and time to review the requested records. <br /> [] CHECK BOX TO EXPEDITE EQU STA$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2-/O•/-) <br /> 1. List up to ten addresses In space below. Sol ct the type(s)of flies from the list below by checking the appropriate <br /> box(es). At least one file t e MUST be selected Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications receiv d after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and cont nt 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. TheilleswillbE 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 re eased 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 AVAILAB E FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Des ription: <br /> Specific Date Range of Information Requested: Fr 3m to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FIL E ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGRWND TANK(UST) Street# StreetName City <br /> CLEANUP SUE(LOP) CONSUMER <br /> 'OTHER CLEANUP SUE(NDN-LOP) t 11 G Dr•' 1 r �'�l'"'I L`r-r ',q S-}6L 1\I D�^ <br /> • E <br /> IHAiMn0U5 WASTE 117 <br /> l I DNRY <br /> N TIERED PERMITTED FACILITY $ <br /> 0ASOVEGROUNDTANK l C �LrLp VAJ 1l <br /> MUST (MONRORING/REMOVAL) oQ 1� r ) j <br /> 0PWS <br /> [gHMAALIMSMATERIALS 1 1�0 1 C'6 ley- • .,, <br /> lZ SPILL/RELEASE RESPONSE ,/� <br /> tZ SOLID WASTE FACIUTY/VEHICLE 4 LOP-(-D J WATMOM <br /> FOOD FACILITY 1 O�, C— C�hA �Gr S�CbI��OY� '.' <br /> POOL/SPA 4.MMGATIGN <br /> OWRY <br /> 6 W Carbi.r <br /> F1 LAND USE APKICATION SITES <br /> SEPTIC PUMPER TRUCK/ [ r M <br /> VMD/CHEMICAL TOES 6 o— <br /> EI y` FbJeINO <br /> L 1 <br /> WASTEWATER TREATMENT PLAN CUPA <br /> ❑HOUSING ABATEMENT T <br /> �MOTEUHOTEL 10 . 1i'- SIOLL <br /> CHICKEN <br /> r <br /> CHICKEN RANCH/DOG KENNELR� in CUPA-UST <br /> Fj MEDICAL WASTE FACILUY 6 )$u D!f1 �w ��K•.MJ S�Q6 Oti, <br /> TATTOoA/BODY PIERCING J <br /> WASTE PRE 6 ��t0 G l� 'jPY SOUO WASre <br /> E]COMPIWNT •J �� ��`� <br /> OTHER(PLEASE SPECIFY); C]AMOUMING <br /> 70 <br /> •f'BOXED AREA-EHO USE ONLY" <br /> E� .rds provided by Staff-PPR Complete. staff N-.1 W <br /> EHD 48-06 -- <br />