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CEIVED <br /> SAN J OA Q U i nivi cinment-al Healy­.. epartnm:7, t <br /> EWRONME ALW-A 7H <br /> P>'rWIT/8EMACES PUBLIC RECORDS RELEASE APPLICATION EHD LOG NUMBER: (a 7 <br /> APPLICANTS '' BUSINESS/AGENCY:GQ_O <br /> ADDRESS: 7Z �(c i'Y`O--YL {� CITY/STATE/ZIP:," c _ "(�o / <br /> PHONE(1): C)P� PHONE(2): FAX OR E-MAIL': n QA II <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will coat o to arran a ppointment date and time to review the request records. -( <br /> SIGNATURE OF APPLICANT DATE n'_-5i � <br /> i I I 1 <br /> 1. List up to ten addresses in the space below. Address ranges WIL' NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(J�sicehd.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. <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 FILE ADDRESS 1 ()h7 L, g '2y-I'7 <br /> HEALTH DEPARTMENT 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) E: iz m_iL b}vb/ W U'�97 W (]CONSUMER <br /> Other Cleanup Site(Non-LOP) , l <br /> RHazardous Waste <br /> u�J �- (7 �v OVJ D.URY <br /> Tiered Permitted Facility /, <br /> Aboveground Tank NJ U (tot''7 <br /> UST (Monitoring/Removal) 3 !� 0 PWS <br /> Hazardous Materials `�! Al • • .L1.�ULg09 <br /> pa'spill/Release Response / C �3�(�� <br /> Solid Waste Facility/Vehicle IJr l E _ Wan=rt OULa�ur-Y <br /> Food Facility l�Z5 6jJY LO-"y 'j ' �r2 a AlU <br /> Pool/Spa <br /> NA` ®Sne MlncanoN <br /> Dalry >�+D� N• •�• 4)M17Q <br /> ❑Land Use Application Sites <br /> E]septic Pumper Truck/ <br /> Yard/Chemical Toilets )�j�5 N• 1 l� HOUSING <br /> Al 0 i/)L O <br /> 11 <br /> Wastewater Treatment Plant w MICUPA <br /> Housing Abatement 7 AST I HM I HW <br /> Motel/Hotel /- <br /> Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing <br /> Souo WASTE <br /> ❑Waste Tire g <br /> Complaint <br /> ❑Other(Please Specify): ACCOUNTING <br /> 10 <br /> iy j—BOXED AREA-EHD USE ONLY" y <br /> -1 L- 1 E- '26.1 ,_ C0 i)-i-, "'C'cz G}ho'A'a. , ` l,,,, v 40,-� C.Q.fn4wti'L <br /> ft <br /> e ' ♦'GIG M L E 48-00 <br /> 1 <br /> 5 n use b� +w ,n r. Pj,DUI , <br /> a-mduv �Ja,�jalt <br /> 1868 E. Hazelton AverlUe ( Stockton, California 95205 T 209 468-3420 F 209 464-38 I www.sjcehd.com <br /> G'. -�-'1, Provibd /,SNI Ato and -1 (,A"a l ,lI� ieif�r; <br />