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J u 1, 14. 2016 12: 52PM No. 0894 P. I <br /> EHD LOG NUMB ER <br /> is F-T, - " I <br /> ATE E34 i i V E D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMqbMF_r= <br /> I U L 1110 6, 1868 East Hazelton Avenue, Stockton,CA 95200mc of' <br /> Telephone:(209)468-3420 Fax:(209)464-0138 VVeb:WWV.jRoUS KIt" <br /> HEALTH PUBLIC RECORDS RELEASE APPMATION <br /> APPLICANT: Azrc�� L6�VfA- BUSINESWAGENCY.- V�c 0 P1 0%,e <br /> A" <br /> ADDRESS: 1 C�3 3 Sk-Z---e— . CITY/STATE/ZIP: t( <br /> PHONE(1): PHONE(2): FAX OR-5'MA11_, <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 /> HECK BOX TO EXPEDITE REQUT-_ 1 3 BUSINESS AYS <br /> UW FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED ND <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 chocicing the appropriate <br /> box(es). At feast 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 WD 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 toil[be confirmed approximately ten(10) <br /> days after receipt of application. The fifes will be held for a rna)�imum 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 P_$130 deposit prior to review'. <br /> VVELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AW'5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: F] List 0 r0ap—Description: <br /> Specific Date Range of Information Pequested: From <br /> S - _ to A: <br /> FNVIROW&ENTAL <br /> HEALTH D F_PA RT M1r:HT FILE AIDDRESS <br /> FILES EFiD USE ONLY <br /> UNoFAaAouNo TANK(UST) street# Street Name city <br /> CLEANUP srrf(L.OP) 0 t ❑ <br /> CONSUMER <br /> 1 3130 F_ rj r <br /> OTHERCLEANUP SITE(Mau-LOP) 'A <br /> HAZARDOUS <br /> WASTE -71 0 DAtFrr <br /> �aT,Gneo Prrmiweo FACILITY (4)13YA,573. F—( Pe <br /> ASOVEGROUND TANK <br /> UST(MONITORING/REMOVAL) PW3 <br /> HAZARDOUS MATERIALS 63 j. <br /> I <br /> Spa.LIRELEA6E ResPON8E <br /> WATER DUALITY S OLID WASTE PAr ILn-Y/VEHICLE 4 cl�_ <br /> 59oo FACILITY <br /> F1 POOL/,SPA EF&T6 MITIGATION <br /> []DAIRY <br /> P1 LAND USE At-PLICATION SITES - HOUSING <br /> L]SEPTIC PUMPER TRUCK/ 6 <br /> YARD I CHEMICAL TOILET5 <br /> XWA_EWATER TREATMENT PLANT �cvm <br /> T]HOUSING AB05mgrff 7 <br /> F]MOTEUHOTEL <br /> E]CHICKEN RANCH I DOG KENNEL 1�(CLIPA-( _, <br /> L)MEDICAL WASTE FACILITY <br /> TATroolSoDy PERoiNG <br /> f�SOLIO WASTE <br /> ,gy,ASTE TIRE 9 <br /> _f3;�COMPLAINT <br /> 17 OTHER(PLEASE SPECIFY); ACCOUNTING <br /> 10 <br /> XED AREA-EHD USE ONLY-" <br /> 11 Records provided by Staff-PFR Cornplete, Staff Name, <br /> Received Time—Jul, 14. "20 16`12: 55PNrNo. 0973 <br />