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DAT ';E IVSD SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMl=1-A i <br /> F i:o 14 201? 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> L'WRON!14'EWAI.HP-ALTH PUBLIC RECORDS RELEASE APPLICATION 015(al <br /> APPLICANT: �LR(,L� �Cwind�e BUSINESS/AGENCY: IRC 9011AhOnS <br /> ADDRESS: 1LyDU Ki0 ja j( 01\0 Ste -71-? CITY/STATE/ZIP: H-On alu lu,j-L q(atfq <br /> PHONE(1): (9)0$) -I29h-Lj((I PHONE (2):� p�)q2]—;U 32 FAX OR E-MAIL: KSWInd�P,(�fizsDlU�lt�►'IS- <br /> Please allow 10 business days from date of application submittal for the records to be available. WM <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 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 (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 to <br /> ENVIRONMENTAL <br /> HEALTH DLESRTMENT FILE ADDRESS EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) (1 v ( B/CONSUMER <br /> (NON-LOP <br /> o S Ghl?�mke6 LnLoch <br /> , <br /> OTHER CLEANUP SITE <br /> HAZARDOUS WASTE DAIRY <br /> TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> UST (MONITORING/REMOVAL) ❑PWS <br /> HAZARDOUS MATERIALS 3 <br /> ®SPILURELEASE RESPONSE <br /> WATER QUALITY <br /> EK SOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY 6/ <br /> ®POOL/SPA SITE MITIGATION <br /> DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 6 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ®WASTEWATER TREATMENT PLANT CUPA <br /> 19 HOUSING ABATEMENT 7 <br /> IXMOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL it CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> I�TATTOO/BODY PIERCING ` SOLID WASTE <br /> FAWASTE WASTE TIRE 9 1 <br /> 111 1 <br /> [Z-COMPLAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> ,D <br /> -BOX AREA-EHD USE ONLY" <br /> on <br /> ILL <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />