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EDEIVED <br /> i` <br /> ; .: <br /> SA N.w4J OAQ U I JUL 2018 Environmental Health Department <br /> C 0 U N T Y-- c;1(t�! > ,,1 PUBLIC RECORDS RELEASE APPLICATION <br /> '"�,�r r.- (:it•r'I,tn;_� f.?r'<;,a,s !,.;I�NVIRONMENT <br /> PEF�PIAIT/sE ItT BY EMAIL• <br /> EHD LOG NUMBER: ��o <br /> 311 <br /> APPLICANT: 1—auli e �A+'5 BUSINESSIAGENCY: S;,j fi d,j 1 ("U_)O('kL.S i <br /> ADDRESS: 1 PI Q He .g i(IJ-ort " �'LA? .V(_ CITY/STATE/ZIP: <br /> PHONE(1): ? `' - - " '`: > PHONE(2): FAX OR E-MAIL: fse <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contactyou to arxan an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT] �! p 2. � _ _ _ DATE <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of type(s)offiles from the <br /> list below by checking fhe appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below, oreniailtoinfo@sicehd.com. Applications received after 3:00 pm will be processed the next s <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> 3. The EMD 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$152 deposit prior to review. t <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 /> ENVIRONMENTAL FILE ADDRESS 3 <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> 'r <br /> Underground Tank(US) Street# Street Name City 4 <br /> `.4 I; <br /> Cleanup Site(LOP) ) `: ❑CONSUMER <br /> t ( �� � <br /> Other Cleanup Site(Non-LOP) ;l l, shd{ wl IIII <br /> n Hazardous Waste t4k DAIRY I <br /> Q Tiered Permitted Facility 2 �r <br /> `n Aboveground Tank _ <br /> vk,UST (Monitoring/Removal) W tt r�W ODO h�� � ❑PWS II <br /> Hazardous Materials <br /> Spill/Release Response <br /> M VAS 11ko _A� U LITr <br /> I�I Solid Waste Facility/vehicle 4 V `2 V <br /> Food Facility <br /> Pool!Spa <br /> SITE MInOAnoN <br /> HA`1L" <br /> Dairy <br /> 5 W <br /> Land Use Application Sites 4- <br /> 5 C0000 j�k1 OUSING 1= <br /> Septic Pumper Truck! a t l/"� <br /> Yard I Chemical Toilets Z�– ul <br /> Ej Wastewater Treatment Plant ���1tiT CUPA li <br /> Housing Abatement 7 h{M� AST/HMIHW I: <br /> Motel/Hotel Z S' 't. �' f J I— <br /> Chicken Ranch l Dog Kennel 5jUPA <br /> r <br /> g <br /> UST <br /> F]Medical Waste Facility <br /> ❑Tattoo/Body Piercing I9 sono WASTE <br /> Waste Tire g f <br /> I! <br /> Complaint II <br /> Other(Please Specify): p AccouNnNc <br /> 10 @€ <br /> ***BOXED AREA-EHD USE ONL7 Y*** <br /> Y <br /> I; <br /> LEIRecords provided by Staff PPR Complete. staff Name: EHD 48•06 <br /> l <br /> i' <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> ( <br />