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f O Y ED • SAN JOAQUIN COUNTY • EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT ���0 <br /> AR Q 4 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> `hWRONtL� 'TALFPF�Tii PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L .�abr�ln PJo1n5 BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: LAII CA AS, 9.40 <br /> PHONE(1): ;x.,96(^ 1310- %79 PHONE(2): FAX OR E-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 appointment date and time to reviewthe 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) LA/lo <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL q 1QS . C_3_'-7 <br /> HEALTH DEPARTMENT FILE ADDRESS "9HD USE ONLY <br /> FILES <br /> UNDERGROUND TANK(USTI Street# Street Name City ' 2 <br /> CLEANUP SITE(LOP) /\�' r llgT O Iq ❑CONSUMER <br /> / OTHER CLEANUP SITE IN' �YL � L / <br /> ❑HAZARDOUS WASTE /.� ^ I ❑DMW <br /> ❑TIERED PERMITTED FACILITY 2 <br /> [ A VEGROUND TANK <br /> UST (MONITORING/REMOVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS 3 <br /> ❑SPILURELEASE RESPONSE <br /> WATER Dunurr <br /> F]SOLID WASTE FACILITY/VEHICLE 4 ❑ <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA ❑SITE MITIGATION <br /> ❑DAIRY 5 <br /> ❑LAND USE APPLICATION SITES <br /> F-1 SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT CUPA <br /> Fl HOUSING ABATEMENT T <br /> ❑MOTEUHGTEL <br /> CHICKEN RANCH/DOG KENNEL UPA-UST <br /> ❑MEDICAL WASTE FACILITY B <br /> ❑TATTOO/BODY PIERCING <br /> F1 WASTE TIRE 11SOLD WASTE <br /> 9 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ACCOUNTING <br /> 10 <br /> —BOXED AREEAA-EHD USE ONLY'- <br /> / / . <br /> ❑ Records provided by Staff-PPR Complete. start Name: <br /> EHD 46-06 <br />