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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAY 9 9 ENVIRONMENTAL HEALTH DEPARTMENT � �� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> !APPLICANT: n�..J fy) �iiS�L��c� rJ BUSINESS/AGENCY: <br /> ADDRESS: (��9 //f/,t, y C CITY/STATE/ZIP:-(y,.& ,,,j 4, ?j LZ I <br /> PHONE (1): as 57-,/t,0! -6 3 C / PHONE (2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to bev . <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-. 13 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT M DATE <br /> 1. List up to ten addresses in thpace 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. 137 <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 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# <br /> '® Street FNName City <br /> CLEANUP SITE(LOP) a �` <br /> LO <br /> CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) S / � — <br /> I4 HAZARDOUS WASTE /pn ODAIRY <br /> TIERED PERMITTED FACILITY 2 <br /> l�ABOVEGROUND TANK / <br /> (y�7nW�J-UST (MONITORING/REMOVAL) F]PWS <br /> HAZARoous MATERIALS 0 <br /> SPILURELEAsE RESPONSE <br /> (n SCUD WASTE FACILITY/VEHICLE 4 WATER ODUITY <br /> ❑FOOD FACILITY <br /> POOL/SPA R5.M71GATION <br /> ❑DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> lYl HouslNo <br /> SEPTIC PUMPER TRUCK/ ❑ <br /> 6 <br /> YARD/CHEMICAL TOILETs <br /> ❑WASTEWATER TREATMENT PLANT (CUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTEL/HOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> 8 <br /> ❑MEDICAL WASTE FACILITY <br /> ❑TATTOO/aODY PIERCING souD WASTE <br /> rrr❑111 WASTE TIRE B <br /> COMPIAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 70 <br /> r / P p '-BOXED AREA-EHD USE ONLY— <br /> 1-(fit- �"' TiYWf r-wj t OIC,' tLAi 4,aAWS? Lwa A16t, P't <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />