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�� & �� <br /> ��� NWrUN�0 ����^����� Health �����mm��� <br /> _ _ __ __ ����_ _ Department <br /> _ <br /> ---00iJNTY4 PUBLIC RECrnKD3RELEASE APPLICATION <br /> EHID LOG NUMBER: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contaQt you to arrange an appointment date and time to review the requested,rec ds <br /> SIGNATURE <br /> '. `~^^'`~' ~~"^^=p=". "='=^`"'= yp=p^/ ". ".es."ux' one <br /> list below oychecking the appropriate uux(en). ftleast one file type MUST boselected. Fax to (209)464-0138, mail to the <br /> address indicated below, or email to info(a)sicehd.com. Applications received after 3:OOpmwill boprocessed 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 below. <br /> 3. The EHDwill notify the applicant ifany EHDfiles exist. Anappointment for review will beconfirmed approximately ten (1O) <br /> days after receipt ofapplication. The files will boheld for amaximum offive business days for review. Appointments <br /> should boscheduled 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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:OOAM-6:O0PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: 0 List E] Map—DeSGription: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) rEHD USE ONLY <br /> F1 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) tool CONSUMER <br /> Other Cleanup Site(Non-LOP) <br /> Hazardous Waste E]DAIRY <br /> Tiered Permitted Facility 2 <br /> F]Aboveground Tank <br /> E]PWS <br /> JK UST (Monitoring/Removal) 0 EYE <br /> F]Hazardous Materials 3 <br /> n Spill/Release Response <br /> El Solid Waste Facility/Vehicle 4 E]WATER QUALITY <br /> Food Facility <br /> Pool/Spa E]SITE MITIGATION <br /> F] Dairy 5 <br /> F] Land Use Application Sites <br /> Septic Pumper Truck/ 6 HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Chicken Ranch I Dog Kennel 8 ACUPA <br /> Medical Waste Facility UST <br /> Tattoo/Body Piercing <br /> Waste Tire 9 E]SOLID WASTE <br /> Complaint <br /> Other(Please Specify): E]Accou <br /> 10 <br /> )E�Records provided by Staff-PPR Complete. Staff Name: :�dv� EHD 48-06 <br /> 1O88E. Hazelton Avenue I Stockton, California Q6205 | T 200488'342O | F 209 464-0138 1 vmww.sjoehdoom <br />