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REIVED <br /> S A N 10 A WN? 6 20% Environmental Health Department <br /> PUBLIC RECORDS RELEASE APPLIC�pTICIIN <br /> ENVIR4NMENfiAL ! <br /> PIEWMSUBMIT BY EMAIL C20103 <br /> y� EHD LOG NM, <br /> UMB • <br /> APPLICANT: 1 1 BUSINESSIAGENCY: <br /> ADDRESS: CITYISTATE/ IP: <br /> PHONE(1); Q - VICPHONE(2): FAX OR E-MAIL:�a�vaifabl�a ` <br /> Please a ow 10 bus! ss sfrom date of application submittal for the records to . <br /> Staff will contact yo to a n n ppointment date and time to review the requeste reco-�d�s.' �� <br /> 81 NATURE OF APPLICANT DATE�n n—is <br /> 1. List up to ten addresses in the siliace below. Address ranges WILL 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,trail to the <br /> addrg-ss indicated below,or email to infoll5sicehd.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 bellow. <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 8152 deposit prior to review. <br /> L AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> EI¢ctronic Information: [I List❑Map-Description: <br /> Specific Date Range of Information Requested: From to j <br /> ENVIRONMENTAL FILE ADDRESS <br /> H LTH DEPARTMENT csa y� p <br /> PILES (Specific addresses only,address ranges will not be accepted) EHD USE Q LY <br /> nderground Tank(UST) Street 11111 Street Nagle City <br /> leanup Site(LOP) t37 W 4' n LOD j 13 e <br /> ❑ l//w1�'/ /{/ <br /> cher Cleanup Site(Non-LOP) <br /> C] Il rdous Waste ��{) J <br /> ❑AbPermitted 2 s3�' 0 t7 r <br /> ❑ gra <br /> Q UST (Monitoring/Removal) 7 11 a/ 1� WI 1 In i /) t Ll <br /> i I, i6l <br /> [ Q <br /> ❑�lazardoua MatedeW {j (Y ` /�� L,r/ (./r' fI � U iU( <br /> pill/Release Response �✓ <br /> HE <br /> olid Waste Facility/vehicle / T <br /> mA- 0 NATER <br /> ;ood Facility <br /> '1 <br /> ❑ h' V <br /> 1/� 1I <br /> col/Spa �. / I G V V oin Mnaannr <br /> Dairy B <br /> 0Land Use Application Sites 12-0 <br /> ptic Pumper Truck p'y Q Haawn <br /> Yard/Chemical Toilets *� r <br /> E]V lastewater Treatment Plant Ia i/� 0 O , <br /> ousing Abatement 7 �V yr /1/js�n AST/Mmi <br /> Wo <br /> [] tel/Hotel <br /> Qhioken Ranch I Dog Kennel /) It 01 CC31 <br /> Waste Facility R <br /> Q a tIr/►I/�d7I ltwy (J <br /> edical <br /> �] ody Piercing <br /> �] rite Tire a SOtO iNae <br /> E] plaint <br /> Q er(Please specify): <br /> i to <br /> 'BOXED AREA-EHD USE ONLY`** <br /> ILUI Lk <br /> Y( .A <br /> o. <br /> <gR Pcords provided bj staff-PPR Complete. staff twine: ' 'A fIalto 14 8-06 <br /> 868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209468-34201 F 2094C"138 wwW.**hd. , <br />