Laserfiche WebLink
REfjEIVED <br /> SAN AAM 4 6 2018 Environmental Health Department <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EltWIRONMEWAL FID4 <br /> P£I'IIMIRYS13IL"E'9 SUBMIT BY EMAIL EHD LOG NUMBER: 001, 103 <br /> APPLICANT: t 1 BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: �j <br /> PHONE(1): — PHONE(2): FAX OR E-MAIL: p !�/Wt <br /> Please a ow 10 busi ss s from date of application submittal for the records to be available. <br /> Staff will contact yo to a ng n ppointment date and time to review the requestedreco ds._ <br /> SIdNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the s ce below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(cDsicehd.com. Applications received after 3:00 pm will be processed the next <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 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$162 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> nderground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) "/ W q n D [3 COWLIMEe <br /> 1 / I� r r <br /> Other Cleanup Site(Non-LOP) <br /> Hazardous Waste ❑1 �,/•�/, <br /> 1 OI I. naso <br /> iered Permitted Facility 2 <br /> boveground Tank �, <br /> ❑UST (Monitoring/Removal) � /t i�{M i In i / I) (�` U i �,� :' { YEW?[:I PWS <br /> 3 y ( rJ/I( f - (/'� 1 'I!M1rfil 11 <br /> Hazardous Materials <br /> n Spill/Release Response '—A <br /> $I olid Waste Facility/Vehicle 4 f r TO y tn/r� � �/� � 7 I E3(NATER OUuin <br /> ❑Food Facility L�L) V v ✓ <br /> E col/Spa I� A / !/��f�. 1 13E MnaAnoW <br /> ❑Mairy 5 (� �/ V �V tV(/J] <br /> Iand Use Application Sites 1 _ <br /> ❑$eplic Pumper Truck/ e 'yi�� rby <br /> ' ^� I ❑F'ous4o <br /> Yard/Chemical Toilets ! w <br /> ❑Wastewater Treatment Plant r O �� ❑CUPA <br /> E] ousing Abatement 7 y V I-` AST/HM!HW <br /> ❑ otel/Holel U <br /> E]Chicken Ranch/Dog Kennel /) fill N y }L 1�/� ❑CUPA <br /> IN edicel Waste Facility a JVrj/1/,►Y/ UST <br /> I] oo/Body Piercing <br /> ---rSam wAstE <br /> aste Tire y <br /> Complaint <br /> Other(Please Specify); E]Auour r <br /> 1a <br /> —BOXED AREA-EHD USE ONLY"' <br /> . Y <br /> 11,(AA ; <br /> i <br /> d R cords provided by Staff-PPR Complete. staff Name: — EHD 48-06 <br /> 868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />