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No, 0410 P, 1/1 <br /> r DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> so AU-6 0 I 2617 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> t +fi/f �NiiP�t- �L Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERMIT/SlER uES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vGLn BUSINESS/AGENCY; RAS I�nl�lrorlmeM' <br /> ADDRESS: CITY/STATE/ZIP: y(� ,, <br /> PHONE(1); SIp- 117-1$8S` 0 PHONE (2): 11-257- 3'50--yq�6 FAXORE-MAIL: <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 appolntment date and time to review the requested records. <br /> HECK BOX TO EXPEDITE REQUEST- F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9--1-1-7 <br /> 1. List up to ten addresses in the sprce 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)464-013a or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 100 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact END 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 aray tC(ap y <br /> days after receipt of application. The flies will be held for a maximum of five business days for review A In en <br /> should be scheduled accordingly. <br /> 4, Any file not returned in the same condition as released will be reorganized by EHL)staff at the expense of the applicant. ` <br /> Kuture file reviews by the same applicant may require a $139 deposit prior to review. <br /> WEU,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 EHD U((''��SE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City RJ <br /> CLEANUP SITE(LOP) ^' j5 <br /> nK7�•'�(�' C `(`f1{1'--' (J(\' .7- E]CONSUMER <br /> OITE 7NER CLEANUP S (NON-LOP) <br /> HAZARDOUS WASTE { 1J <br /> A ~I / �• ❑DAIRY <br /> TIERED PERMUTED FACILITY ` <br /> 15dAeovEoaouNDTANK 2 �G��ev� <br /> UST (MONITORINGREMOVAL) PVJS <br /> AROUB MATERIALS c` <br /> SPILLURELEASE RESPONSE (• �i'1 <br /> /�\� WATER QUALITY <br /> OLID WASTE FACILITY/VEHICLE <br /> FOOD FACILITY A`{ n` <br /> n POOL/SPA '`� � M <br /> ..L <br /> YE MIT�C�YIQ"1 <br /> DAIRY <br /> 'LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑Houma <br /> e <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT � COPA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHOTEL <br /> E]CHICKEN RANCH/DOG KENNELA <br /> n-J <br /> S/LIPA-UST <br /> Ij MEDICAL WASTE FADILITY 13 I]TATTDOIBODY PIERCING <br /> WASTE TI RE r J` SOLID WASTE <br /> ;KLe (\ <br /> COMPLAINT <br /> E]OTHER(PLEASE SPECIFY): E]Accouw,NO <br /> is <br /> 60XEP ARPA-PHP USP ONLY— <br /> r + +p <br /> _ (A � V� <br /> Y� <br /> Ll Records provided by Staff-PPR Complete. Staff Name; <br /> Received Time Aug, 1, 2017 2: 59PM No, 2016 <br />