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RECEIVED <br />DATE RECEIVED EHD LOG NUMBER <br />1 2011 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />hWPtOWENTALmm.THL 1868 East Haz�lton Avenue, Stockton, CA 95205-6232 <br />PEAMtT/ E:Z`,zr,F elephone: (209) 468-34 0 Fax: (209) 464-0138 Web: www.sj'gov.org/ehd 95(9013 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: /� F r : n BUSINESS/AGENCY: / <br />r r ri ( �v�a vTQtr.w( 4• S�;en� <br />ADDRE;iS: Lra,n e� 0 s8iI CITY/STATEIZIP: <br />PHONE (1): (, D PHONE (2): q16• FAX OR E-MAIL: , ;� y <br />( SO -P- -ele-5:, <br />Please allow 10 business days from ate of application submittal for the records to be available. <br />Staff will contact you to arrange an ppointment date and time to review the requested records. <br />CHECK BOX TO EX DITE REQU ST► $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />1. List up to ten addresses I space below. Sel ct the type(s) of files from the list below by checking the appropriate <br />box(es). At least one filet a MUST be selected Fax to (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications receiv d after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and cont nt of EHD records, please contact EHD at the number rioted 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 re uire a $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAt FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: Q List ❑ Map — Des�ripti( <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />DEPARTMENT <br />FILES <br />FI E ADDRESS <br />EHD USE ONLY <br />-�H(EALTH <br />I}(I UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />1 <br />l� <br />�� 1 <br />�r, <br />)t,�� q <br />r�"-<�.J, <br />s���-�D v\�'� <br />r ❑CONSUMER <br />QTc-'��CLEANUP SITE (LOP) <br />17V OTHER CLEANUP SITE (NON -LOP) <br />HAZARDOUS WASTE <br />/ <br />f� <br />Y <br />�`,/' G ❑ DAIRY <br />® TIERED PERMITTED FACI <br />I <br />I <br />ABOVE -ROUND TANK <br />( <br />c' <br />P5 UST (MONITORING / R VAL <br />'t.i <br />G <br />�Z, L <br />' 0 «# ❑ PWS <br />HAZARDOUS MATERIALS <br />3 <br />1 g� <br />1 <br />�. <br />'� er 1�-1!.�'rr-F{ <br />(,� <br />SPILL/RELEASE RESPONSE <br />(/r+ 1 _ <br />`"'\p� <br />j , // b`� <br />�P <br />ry} - <br />5 tJ 40� <br />SOLID WASTE FACILITY / VEHICLE <br />4 <br />3� `� E4 WATER QUALITY <br />❑ FOOD FACILITY <br />`— <br />(' "" <br />POOL / SPA <br />� SITE MITIGATION <br />DAIRY <br />5 <br />f g�J <br />� l.-�✓li.r <br />I L/' �"' ��1 <br />V �r���Dr�, � <br />y1i1 !�'�✓✓�rI <br />� I% r+ <br />❑ LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK/ <br />YARD / CHEMICAL TOILETS <br />I VD� <br />( 'Cl f <br />., � L�- <br />L ��b�,✓ <br />❑ HOUSING <br />WASTEWATER TREATMENT PLANT <br />HOUSING ABATEMENT <br />! <br />r <br />If <br />T <br />L <br />I^f ry <br />`U <br />C (� �./1i' l �1•� C _ `�"�l� <br />p j +L+ <br />CUPA <br />�_A('7`/ ,..}�,V��,rl, Ate' 4 <br />f`� V (�a/i L• <br />❑ MOTEUHOTEL - <br />h <br />J e 1 v /� <br />11/••IL�1-'I��O1'� --'. <br />CHICKEN RANCH / DOG KENNEL /CUPA <br />MEDICAL WASTE FACILITY V <br />8 <br />l•g <br />��M.� �w�Vx� <br />''�Dyy <br />- UST <br />�•^'� <br />❑ TATTOo/BODY PIERCING <br />9 <br />1��� <br />'Vi <br />W l rj r YJ NY <br />-1y <br />J�21C'� 1 G✓�'� <br />{ e .r� (_ q _,y��°/'SOLID WASTE <br />'l0 C.' 1 s�J I Cf1 f'�?l it �/ r� <br />a WASTE TIRE <br />COMPLAINT <br />f� 1�w <br />OTHER(PLEASE SPECIFY): <br />OL <br />40 '71 '34" i j- ACC NG <br />10 <br />❑ Records provided by Staff <br />EHD 48-0 -- <br />- <br />Co 4 <br />po�13� <br />'5 5' <br />Comnlete. <br />iTVV <br />vi <br />L�ti`�J <br />USS 4-1 ��- <br />i1t'� <br />So <br />% <br />L e—S) I <br />