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E <br /> r ` 1 FI ; <br /> DATE RECEIVED' ,SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> LEy 6 2016 ENVIRONMENTAL HEALTH DEPARTMENT 952 <br /> 1868 East Hazelton Avenue, Stockton,CA 95205.6232 <br /> iR NMENITAL FEALTEf Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> €PEERfITfSE I PUBLIC RECORDS RELEASE APPLICATION 1 _ <br /> APPLICANT �1 ra11SN�E`SSIAGENCY: �3��_ =�' t✓'_I f e�L' <br /> ADDRESS: f(^ F. � J . /+-; S� "' () ---- -- .-'1I'I341STATEfZIP: <br /> PHONE(1): ��(j�- T'�-' 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 review the requested records. <br /> ❑CHECK BOX TO EXP TE REQU�ST•$1130 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTKLM_ <br /> 1. List up to ten addresses In the space eiow. 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(2091 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£130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:06PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS t <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name city <br /> • �,[CLPANUP SITE(LOP) (} E'Cu,,:uuER <br /> LJ OTITER CLEANUP SITE(NON-LOP) t I C)411 j 1'i ,^e• W• Tww <br /> I. <br /> HALNOOUS WASTE , `Y�'E/ [[ C]D.n' <br /> R RW <br /> PERMU <br /> TED FACILITY 1010r; VV / I ^� k <br /> -MOVEcROUNnTANK EpE, <br /> I <br /> UST (MDNRORING/REMOVAL) <br /> 5{{555 <br /> HAZARDOUS MATERIALS <br /> SPON I V/ ✓r �V (/L. 1 1 ' <br /> $PILL/IYELE/$E RESPONSE <br /> � �'W'ATErt OVIJIY <br /> $OUO WASTE FACILT'I VEHICLE A �/�2 <br /> ff�FOOD FACILU I✓✓J� 19114 r �� t P'" -.�J'SITEWMATI . <br /> ❑POOLI SPA ./1 1) �/��jj nl .y(�/� p'$Ire MmnnnoN <br /> DORY 5 IOgf I U,N t h (l-VV. . ' E '/ <br /> ❑LAND USE APPLICATION SUES 1 <br /> HOIIANG i <br /> SEPTIC PUMPER TRUCK/ E ( <br /> Jy <br /> YARDICHEMICALTOILM (L <br /> rjl WASTEWATER TREATMENT PVWi ly (2 CU PA EIF <br /> HOUSING ABATEMENT T <br /> MOtEtlHDTEL � r r 1(fill"•vA,• •✓✓f f <br /> ❑CHICKEN RANCH/DOG KENNEL �UPA HAZ#TAT <br /> e <br /> MEDICAL WASTE FACILITY <br /> TA70WBODY PIERCINO ®Sa;m Wm'rt <br /> WASTE TIRE a �//J <br /> GO.PUANT �Law I"�' vtF •�• �.-+' ( I{{{), <br /> ��`111''''''111OIHER(PAf.GC'J'rtlNf. <br /> l�' LEASE$PECIFYII -„ n <br /> � <br /> —BOXE EA-EHD USE ONLY" <br /> - <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4346 <br />