Laserfiche WebLink
US/LUI/ y:ll HI°I n5J/ULbSLL -91GU74b4U13e !.J 1 <br /> rtvirorzrvot?ntal Health DepartmentSANsJOAQURECI <br /> APPLICATION <br /> OCT � � 7037 PUBLIC RECORDS RELEASE APPL <br /> • a::.: 4 , r:.y, <br /> EICII/IRONtsh'ENTA(,FiEALTk EHD LOG NUMBER: 7X01 <br /> APPLICANT. , „(j �'( BUSINESS/AGENCY: `y-0A -C <br /> n <br /> ADDRESS: �'' ia . ...r l`KG� <br /> - Jai P I�%`t°.SitiO! P �- CITY/STATE/ZIP: <br /> E-MAIL: �5 lyl <br /> /Ir[�� 22 <br /> Please allow 10 business days from date of application submittal For the records to be available, <br /> Staff will contact yo o arrang�an�p�pFp�lntment date and time to review the requested reco ds., C d <br /> SIGNATURE OF APPLICANT �p >./ G?�� �� OATE '-7 <br /> 1. List uo w ten addresses a the space b ow. Address ranges WILL aOT be accepted. Select the s of les from: e <br /> Est below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(2091�-0138 mail to the <br /> address indicated below or email to <br /> bus,nesa day. info(olsirnhA corn Applications received after 3:00 pm will be processed the next <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted below. <br /> 3. The EMD 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 Ave 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. ' <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 /> 1— FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> vgUnderpwund Tana(UST) Street it Street Name City <br /> sahup site(LOP) <br /> p J F.�. ❑ <br /> Cleanupsita(Nor-LOP) �y �j, cwt <br /> Ha2ardpa9 Wade C <br /> �`[� _ ❑Dual <br /> • . orad mtmd Ta Facdtly Z J ifl 1+ �� ,,1,,. <br /> �..,wvaground Tank i Y fJe&'Id <br /> (r tl T (Montodng i Rem rvsl) 0 PWS <br /> Hnerdous Mateda+s 3 <br /> �id/Release Response <br /> WillWas,e Focality l Vehicle a IVI 1''ll'I 6] area ouam <br /> ❑Food Facrty 7 I C/D flyo <br /> ❑:PON J Spa <br /> rr++�, Sns A4i�e�l%1: <br /> '.U..Deny s <br /> ❑land Use A 0iceYon sites <br /> .❑':septa Pumper Truck a ❑F,ars:xc <br /> Yee d Chenka!TWOS <br /> LJ waeteN2ter Treatment Plam <br /> MICUPA <br /> :❑:Hpysmg.Abammemt i ASTIHM/HW <br /> _❑MpfaUHotel <br /> _-.❑-Oialrell-Ranch)Dog Ker:net G1PA <br /> Medical:Waste Feedity a us7 <br /> _':❑Tattoomodv Piercing samwnsre <br /> 0 waste rare 9 <br /> ..�CemPmint <br /> Other(Please spedty): ❑ACFS,UM4m <br /> ,e <br /> ••.00XED AREA-EHD USE ONLY"' <br /> t7--iS—L t <br /> : <br /> Racorils rovided by Staff-PPR Complete. snff N.; Exoia us <br /> 1868 E_ Hazelton Avenue I Stockton,California 95205 I T 209 468-3420 ) F 209 464-0138 ) arovw.sjcehd.coi'n <br /> Received Time Oct, 3, 2017 9:06AM No, 2386 <br />