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� <br /> SAN: JOAQUINRECEIVEDironmenlfa � o ��p �� ��: <br /> COUNTY-- - PUBLIC RECORDS RELEASE APPLICATION <br /> Grc-otness grUt,'c There AFIR 1 ? Mo a <br /> EHD LOG NUMBER: <br /> APPLICANT: G RBf�M'TlSER4VXJ BUSINESSIAGENCY: �f� r s SS'oG <br /> ADDRESS: �I/r rb CITY/STATEIZIP: <br /> PHONE (9): 5--0 � PHONE (2): FAX ORE-MAIL OWnhz)LJez)u�t uD(- <br /> Please allow 10 business days from date of application submittal for the records to be availableYQlr ,a <br /> Staff will c you to, a e an appointment date and time to review the requeste records. J <br /> SIGNATURE OF APPLICANT DATE, 1 Q <br /> 1. List up to ten addresses in a space b ow. 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(aj)sicehd.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 far 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. <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 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (SPecifc addresses only, address ran9es w4 <br /> 11 riot be accepted) EHD USE ONLY <br /> R underground Tank(UST) Street.# Street Name City <br /> Cleanup Site(LOP) :�U [I CONSUMER <br /> Other Cleanup Site(Non-LOP) W , aJ L477�K' � <br /> Hazardous Waste <br /> Q©AIRY <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> UST (Monitoring 1 Removal) L]PWS <br /> ❑ Hazardous Materials s <br /> is.E: n l <br /> Spill 1 Release Response { <br /> GI i+� CATER qunurr <br /> Solid Waste Facility!Vehicle q <br /> ❑ Food Facility LJ :}u <br /> Pool I Spa SITE MITIGATION <br /> Dairy 5 <br /> ® Land Use Application Sites <br /> Sepfic Pumper Truck 1 E]Houslwc <br /> s <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 - ASTI HM!HW <br /> Motel/Hotel <br /> ❑ Chicken Ranch/Dog Kennel []CUPA <br /> 8 <br /> ❑ Medical Waste Facility UST <br /> Tattoo/Body Piercing SOLID WASTE <br /> Waste Tire g <br /> [� Complaint <br /> F-1 Other(Please Specify): L]AccouNTNG <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> Records provided by Staff-PPR Complete. Staff Name: S., 11\ sHoas-os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 f T 209 468-34201 1= 209 464-0138 1 wwW.Sjcehd.com <br />