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RECE <br /> D I�� '�'" HD LOG NUMBER <br /> SAN JOAQUIN COUNTY EHD <br /> — <br /> NOV 16 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • EM/IRCU�fdENTAL HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 31zGY1 Nc'eytd C7 BUSINESSIAGENCY:SCAVI 30aQtjo0 C014- Q41bjrWD <br /> ADDRESS: 1T\0 C + 1+4AZtA {U✓1 A-V-e. CITY/STATEIZIP: C� 52O/'I <br /> PHONE(1): "- L4 fog - ,gQ (0 6 PHONE(2): FAX OR E-MAIL: IGCiCCV 2(.I O n0 S1vLA/�Of< <br /> Please allow 10 business days from date of application submittal for the records to b�available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDIT + - EE(CF�,St R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� �// DATE <br /> 1. List up to ten addresses ace a ow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one fie a 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 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From 77 to t I ( 1 Li <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> (�UNDERGROUND TANK(UST) Street# Street Name City <br /> • CLEANUP SITE(LOP) ?((�l-1 C•f��( I�((�w QC.A T�..�� "" ONSUMEP <br /> + lJJ Y C.A d-r k)eC <br /> OTHER CLEANUP SITE(NON-LOP) 11 [� {+I/�- I 4 <br /> HAZARDOUS WASTE 3151)1 C(.1�'r0L( 1�l to w Rd 1 Y{nC <br /> v y DAIRY <br /> ❑TIERED PERMITTED FACILITY 2 I <br /> ABOVEGROUND TANK 1 �. ' 1 <br /> (JUST (MONRORING/REMOVAL) 0,0�0� CO rfcal t}0I IOW � � <br /> T' /Li A [IPWS <br /> Q HAZARDOUS MATERIALS S `-'� <br /> rgSPILURELEASE RESPONSE -f'Jf��[(L�,M.�•�11 /�,,� ( r� - 1 ,♦L <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 WVtlV �Of�fAl I}U •'�W 1`U Ttlf/�\-J I �(� ( Jl WATER ODALIT, <br /> ❑FOOD FACILITY - 11 �-Vi, Vr/ <br /> ❑POOL/SPA DE MITIGATION <br /> ❑DAIRY 6 p <br /> ❑LAND USE APPLICATION SITES ^, C,A <br /> co <br /> ❑SEPTIC PUMPER TRUCK/ t T5„,�- HOUSING <br /> 6 1 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT 1(`y1_1 <br /> UPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOML/HOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY 6 <br /> TATTOO/BODY PIERCING <br /> ❑WASTE TIRE ❑SOLID WASTE <br /> 9 <br /> ❑COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): <br /> ❑ACCODNI'ING <br /> 10 <br /> "'BOXED AREA.EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. Stan Name: <br /> EHD 48-06 <br />