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Ch..el. - a'?4�`a..:_ o- �e.4e�_u..!.�y,.._Y.._.ra.._�.�v�.u.. _...�—#e'._�'L.. -_:' _�°��.ssaaLu�. . .....u,._...... " .. ___• <br /> I , <br /> DATE RECEIVED EHD LOG NUMBER <br /> AU6 Q 00 2016SAN IOAQl11N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> PLTH1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Ao{R'ONtd EEP.I-H� Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PE fJ6T/SEf�AiCES PUBLIC RECORDS RELEASE APPLICATION <br /> n q APPLICANT: - 66 LBUSINESS/AGENCY: EZ'_ <br /> (ooSUI hA� <br /> ADDRESS: _'20-1 I D.Q. S.h.,p ?4 4 310 CITY/STATErziP: &0 ?ClE f- <br /> PHONE(1): 4yZ,0-Z PHONE(2): FAXORE-MAIL: /iln ,2 C.:�hllr.v-Wrf!!^") <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 /> ❑CHECK BOX TO EXPEDITE nREQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> �� <br /> SIGNATURE OF APPLICANT 2Qej DATE <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a 9139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:09PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List❑ Map—Description: <br /> Speck Date Range of Information Requested: From -FITS-1 QVCi 11Qblp to jJ fse/I j <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> �1NDERcvax�ND TANK(UST) Street# Street Name city <br /> • <br /> CLEANUP$RE(LOP) I1, L1 , f� I �COxsNAEP <br /> ;3-6-ER CLEANUP SRE(NON-LOP) 38OD Wes } laJAfy CIL, Ud. S XIe IWDP4-1 , o,kLP <br /> Co <br /> 3HAURDOus WASTE 0 DaR. Q <br /> -D PEPYITTED FAcn y �/� 1 1Il <br /> ABOVEGROUND TANK ((�� d) V <br /> 1 <br /> J2'15ST(MDNrtoWNG/REMOVAL) fel ,� ❑PWS <br /> �WZAROOUs MATEPNLS � Iy'�J{�I <br /> $PWLEAS <br /> I REE RESPONSE V/AO-1 V <br /> 0SOLIDWA FACWTY/VEHICLE A WATERDUALIY <br /> FOOD FACILITY <br /> Pool I SPA Sn M'N;,mN <br /> DAIRY 6 <br /> LAND USE APPLICATION SM <br /> 2�1SEPTCPUMPERTRUCK/ ❑HDUBIIY' <br /> 8 <br /> YARD I CHEMICAL TGILET$ <br /> ll W!$TEWATER TREATMENT PLANT <br /> CUPA <br /> �HOUSINGABATEMEMT T <br /> MOTEIMOTEL <br /> CHCKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEUM WASTE FACIR B <br /> TATTOOMODY PIEWNG <br /> WASTE TIPS ❑SOLID WA9TF <br /> B <br /> COYPWNT <br /> ❑OTHER(PLE/SE SPECIFY): <br /> ij 1D ❑AyJVMING <br /> —BOXED AREA-END USE ONLY— <br /> • <br /> E <br /> ❑ Records provided by Staff-PPR Complete. sten NADIE: <br /> EHD lad6 <br />