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RECVE® SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV t 8 2016 ENVIRONMENTAL HEALTH DEPARTMENT 815100 <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232ENVIRONMENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> • PE-RMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 {✓ - BUSINESSIAGENCY: fM�✓t(,t� C YlC <br /> ADDRESS: Vv�qD CITYISTATEIZIP: D 27 0 <br /> PHONE(1): PHONE(2): FAX OR E-MAIL:-t. VA,f`GZAJ EUru-n 4 <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 /> ❑CHECK BOX TO EX TE REQUES -S F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINF. S DAYS <br /> SIGNATURE OF APPLICA DATE SIA , <br /> 1. List up to ten addresse -in the space be elect the typ ( f files from the list below by chat 1 theappropriate <br /> boxes . At least one file <br /> ( ) type MUST be acted. Fax 20 0138 or mall 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT REC RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List CkMap—Description: dYl 1(A/1M <br /> Specific Date Range of Information Requested: From to �J <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> NDERGROUND TANK(LIST) Street# Street Name City <br /> //CLEANUP SITE(LOP) /� , 1 Llgvi.�tvµE,lt;.,-t;, ❑G„gouEa n <br /> • I/i O*rytR CLEANUP Sat(NON-LOP) T VY'I' .1✓f N �n G/ v� � <br /> it AIARDGUS WASTE M1/ t. ♦a.A 0uar 4" <br /> k.56�'04-EREO PERMITTED FACN(fY Z �N°AL �( I- ULe 'Lo <br /> —/eGVEGRGUNO TANK EYl 'J••i��,�VVV lInE, N <br /> U$T(MONITORING I REMOVAL) –•— L� ❑PWS <br /> H RDOUS MATERIALS �,T L,�L III 1 _ _ / l(/�-1— <br /> $PILURELEASERESPONSE t{'LY 1F{IE K'1'IIE`•1 V I l/L <br /> ,Saw WASTE FACILITY/VEHICLE a /�! 'r1{.,iE..,A,p/t L 1,1ZZ y, I.Co WATm OuMRr <br /> ❑FaoG FACILITY NJ��111Rn l!(`• T LTU -u�t•Ji�11'C - IX _l-� <br /> ❑POOL/SPA sar MITCAP.N <br /> TAIRY 5 �• '�E Iv• • t <br /> USE APPLICATION SITES <br /> EPTIC PUMPER TRUCK/ ❑HOUANO <br /> ARD/CHEMICAL TOILETS ° <br /> WASTEWATER TREATMENT PUNT QN <br /> �I CUPA <br /> HOUSING ABATEMENT T I✓71�1 <br /> MOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL En CUPA-USt <br /> ❑MEDICAL WASTE FACeT1Y ° <br /> TATTOOI8CDY PIERCING <br /> WASTE TIRE SOLID WASTE <br /> 9 <br /> ❑COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY) ARpUNRAO <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> • <br /> ❑ Records provided by Staff-PPR Complete.staff NPIRo: <br /> EHD 4346 <br />