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IECEIVED <br /> LE .COP7 <br /> SANLROWENTALDEC <br /> 2 207 <br /> aAQUIEnvironmental Health Department <br /> HT PUBLIC RECORDS RELEASE APPLICATION <br /> COUNTY— <br /> aeotness <br /> �. RMiT/SERVICES <br /> :7ro„vs here. PE . <br /> EHD LOG <br /> �NUMBER. <br /> APPLICANT: (, BUSINESS/AGENCY: cia Zv_r) C_61'Cl1..' , PW <br /> ADDRESS: -L, CITY/STATEIZiP: Sika 6A q5, of_u_ <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: 0,5pL Zzt'C�S 1QyJ UYC� <br /> Please allow 10 business days from date of application submittal for the records to be available. �J <br /> Staff will contact y �to arranWa of ent date and time to review the requested r cords <br /> SIGNATURE OF APPLICANT �a DATE 1 2- 12t;? )f r <br /> 1. List up to ten address” the space efow Add es ranges WILL NOT be accepted. Select the typ (s)o files from the <br /> list below by checking the appropilate box(es). A ast one file type MUST be selected. Fax to(209)464-0138,mail to the 4 <br /> address indicated below,or email to infoPsicehd.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 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$152 deposit prior to review. t Z jZ <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 (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) t `"t0 ��ch <br /> Cana y_.� A • CONSUMER <br /> ;Other cleanup Site(Non-LOP) V ( r C{lam <br /> I <br /> Hazardous Waste <br /> DAIRY i <br /> X.Tiered Permitted Facility 2 <br /> " nr7 j b IS- V d �/ <br /> Aboveground Tank U V l l u <br /> UST (Monitoring/Removal) ',I r J]PWS <br /> Hazardous Materials se/ ��{/Lf�j t~� rT L Cb�'�� i <br /> Split/Release Response <br /> Solid Waste Facility!Vehicle ., nrERquulry ! <br /> Food Facility 4 cra) '' Y � I <br /> 0 Pool/Spa [ / ^_ .MMOATION <br /> Dairy s01 <br /> IK UTzi�� � <br /> Land Use Application Sites P �.! <br /> Septic Pumper Truck/ _ �uslNc <br /> Yard/Chemical Toilets `(" � C_F C ' V Y etch`4'," <br /> Wastewater Treatment Plant ( CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> [F1 MoteUHotel I <br /> Chicken Ranch/Dog Kennel / UPA <br /> F1 Medical Waste Facility S fC� <br /> J <br /> UST <br /> ❑Tattoo/Body Piercing <br /> 1 SO41D WASTE <br /> ,,,,,,////Waste Tire g <br /> ������XComplalnt <br /> Other(Please Specify): AOCOUKMNG <br /> 70 <br /> ***BOXED AREA-EHD USE ONLY*** q <br /> 1'1--�:J--n— Eh� 1 `lar, rece:p-E 4 pr"Rj� r 9� e_ku, OL- - vz1•ali i�:•� <br /> t <br /> y <br /> a <br /> 0 Records provided by Staff-PPR Complete.staff Name: EHDaeus1] 6 <br /> 4 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 E F 209 464-0138 1 www.sjcehd.com <br /> ( <br /> i <br /> t <br />