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�lCTE v V E DEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> SEP 18 2017 ENVIRONMENTAL HEALTH DEPARTMENT III <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)488-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL � PUBLIC RECORDS RELEASE APPLICATION <br /> PFfiM1T/SFIA11CF9 _ <br /> APPLICANT: 1,11,41y RtJJCh2.✓ BUSINESS/AGENCY: Ej2C <br /> ADDRESS: 1 F Ayld ne F/a G}/ T' CITY/STATEZP:-J1�a1'-0V , (_4 I <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: jt;a11A y 10 FIzN <br /> Please allow 70 business days from date of application submittal for the records to be available. ter;l <br /> Staff will contact you to arrange an appointment date and time to review the requested records. cp-y.., <br /> HECK BOX TO EXPEDITE V4QUE§T-$13y EE(CASH 9R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT !/ DATE <br /> 1. List up to ten addresses in tHe spat b ow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one Tile type MUST be selected. Fax to(209)464-0136 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:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑List❑Map—Description: <br /> Specific Date Range of Information Requested: From 1100 to -2 01} <br /> ENVIRONMENTAL <br /> HEALTHDEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> 21 N0MGRWNDTMK(UST) street Street Name City _ <br /> ^�CIFA�NUP SDE(LOP) L6 n /� -��7/� �, CAN511MER <br /> De-m C1 uPS INON-LOP) 1 -7 o I r 1 s u'� P%d IVa <br /> �HazwDws wmm 0 <br /> TiEREn PEu FAc%rt 2 <br /> AWp GRWND TANK <br /> l RFM <br /> ST(MONRGRING I GVF <br /> 61 L) <br /> Pw5 <br /> OVS MATERIALS 3 <br /> �'SPIWRElE0.5E FiEGPpuSE <br /> Ai910uN1m <br /> agwD WASTE FAcum I VENIGUE 4 <br /> Ej fGDD FALLRY <br /> 50E MRIGALION <br /> ❑PWLISPA <br /> ❑DAIRY 6 <br /> ❑LANO USE APPl1G SRES HO�SIt#+ <br /> ❑SE TIC PUMPER TRUCI(I ❑ <br /> 6 <br /> YARD/CHENMAI.TOLETS <br /> r]WASTEWATER TRFATMEtR Pt IIIy WIPA <br /> E]HOUSING AaArEMENT r I,rY 41 <br /> ❑MOTMJHOT <br /> ❑Cmc RANai l DOG KENNEL CUPA-UST <br /> ❑Mwim WASTE FAcu 6 <br /> ❑TATTOWB=PF.RCRIG D WASTE <br /> WASTE TIRE <br /> 9 <br /> RGOMR T <br /> ❑O1NER(P F E SPECIFY): ❑ACCgMf1NG <br /> 10 <br /> '"BOXED AREA-EHD USE ONLY'-' <br /> --t"fQ v L 1,rM•t A:, X71 h T rt5:c=1(1. .^M2.r kAAD [011. 4' <br /> e <br /> ❑Records provided by Staff-PPR Complete.staff Name <br /> EHD 4"S <br />