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RECEIVED No, 0410 P. 1/1 <br /> DATE RECEIVED SAN .IOAQUIN COUNTY EHD LOG NUMBER <br /> 1 2017 <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1: (2 East Hazelton Avenue, Stockton, CA b:www.sjgoV.org/eh,,Nf�6ffTal-tii`A!LFH Telephone: (209)408-3420 Fax: (209)484-0138 Web:www.sjgay.org/ehd <br /> ' _RMITISERIVIGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v BU5INES3IAQENCY: L5FAS eA0ronmen <br /> ADDRESS: IS'" a ,�-r.eL ti. 0.n - �-j CITY/STATE/ZIP:�y��(.�r ,(�--(jt��-. 19 4_0-4f I <br /> PHONE(1): ,SIO-�i'17-'$8,$—x,30raPHONE(2): �I�i'3'SJ�• q. FAX OR&MAIL: 0.VllvW6;7— <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> HECK BOX TO EXPEDITE REQUEST�y79 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9-1-1-7 <br /> 1. List un to ten addresses in the Spifice 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 flies 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$139 deposit prior to review. yV!/ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name city <br /> LEANUPERE(LOP) <br /> �tO,J$JqL� <br /> �CONSNMER <br /> up SG (NON-LOP) so SL " v1— ^ <br /> OTRER0.FnN <br /> HAURDOUS <br /> W16TE <br /> ❑DNFT <br /> TIERED PERMITTED FACILITY 2 <br /> jF10D <br /> 90YeGRWNoTANK �ST (MONITUS MAT.PU REMOVAL) �� 1. n 1 p ❑PWS'T 'M NIOR' 0 LSB PILL/RELEABE REBPONEED WAS7EFADIIM/VEHICLE /i/I/� I �I� I ' CATER OUnuIV <br /> FAGLnY <br /> ❑POOL/SPA 1uI r L�MIY GAYON <br /> E]DAIRY 5 10 <br /> 'LAND USE APDLIOAnON SITE$ <br /> ❑SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> YARD/CHEMICALTOUTS S <br /> A WASTEWATER TREATMENT PUNT OPA <br /> ❑HOUSING ABATEMENT r <br /> ❑MOTEIMOTEL <br /> ❑CHICKEN RANCH!DOG KENNELUPA-UST <br /> ❑MEDICAL WASTE FACILR R <br /> ❑TATTOO/BODY PIERCING <br /> 0 WASTE TIRE Sou.WASTE <br /> 9 <br /> COMPLAINT <br /> E]OTNER(PLEABE SPECIFY): <br /> E)ACCOVNiINB <br /> 10 <br /> q ••.BOXED ARB11A11-RHO USE ONLY-- <br /> V (� <br /> f1 � <br /> L7 Records provided by Staff-PPR Complete. stArt N-m <br /> Received Time Aug. 1. 2017 2 : 59PM No. 2016 <br />