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DTFRECE"VE® SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 5*NiJAN 1CI 201 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> awlIkONMENTALM`�d.71H PUBLIC RECORDS RELEASE APPLICATION <br /> •—I�MIMTJa6I�'I . <br /> APPLICANT: II BUSINESS/AGENCY: TP(�hnl� gh AjnP,PjY" <br /> ADDRESS: z{rj q (U YlraviI.P� Ave, Sre I Dep CITY/STATEIZIP: FreshO, ( 93 2l <br /> PHONE(1): �55q) 2f3m' 5 W(p PHONE(2): 91 ;-1tp–(oil XZII FAX OR E-MAIL: rVAh f�chnlfp✓1,YIQk <br /> Please allow 10 business days from date of application submittal for the records to bee availab ee. <br /> Staff will contact you to arrange an appointment date and time to review the 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map– Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> R UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) Ufl(AIYI � Manw CONSUMER <br /> WV� <br /> ' <br /> OTHER CLEANUP SITE(NON-LOP) 1 1 �/ _ <br /> HAZARDOUS WASTE El DAIRY I�I9 <br /> fv�TIERED PERMITTED FACILITY 2 X55 N uniski l Nei 061WOU n <br /> (�ABOVEGROUND TANK ) f17^Vt�a,Q.�(',/J <br /> [(UST (MONITORING/REMOVAL) IY..y� ❑PWS <br /> 'q HA2ARDOUS MATERIALS 3 "� N Uncoln Nva Man�cc� -,�-/-f✓✓' <br /> foSPILURELEAGE RESPONSE -JF <br /> IDI SOLID WASTE FACILITY/VEHICLE 4 (p35 r! Lincoln Rv6 MgnKm WATER QUPNY <br /> 7 FOOD FACILITY <br /> F-I POOL/SPA ��Lry{,f Ri SITE MincaD.N <br /> DAIRY 6 VL✓ I N C-Ant EWA Mank�a, <br /> EZ LAND USE APPLICATION SITES — rL <br /> SEPTIC PUMPER TRUCK/ fi �D�IP tv�ai,r/�' SI" ��^ HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ELWASTEWATERTREATMENTPLANT (I,1/ /A� A, F 1110 1_LD CUPA <br /> �.,HOUSING ABATEMENT 7 D�tf Ivl �Kn� <br /> MOTEL/HOTEL 1 "l <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY B <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE SOLID WASTE <br /> 9 <br /> j COMPLAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> I <br /> ••'BOXED AREA-EHD USE ONLY" <br /> 71r] <br /> Records provided by Staff-PPR Complete. StaffNeme: <br /> EHD 4&66 <br />