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�Q U jEa ,\,,,I°onrrnerr�li9 G=ear t' ro ���3ail.a1t11�fNi� <br /> �0 1-5--2017D U N TY- PUBLIC RE RDS RELEASE APPLICATION <br /> Greatness arOwS here. ��� <br /> E-WvlkbNMENTAL HEALTH EHD LOG NUMBER. 25 <br /> PERMITIREEMCMC <br /> ( APPLICANT: Gr\enow 0 • doo n BUSINESS/AGENCY: <br /> ADDRESS: flAaabcun, CwQ, CITY/STATE/ZIP: ,y0 UO , GAq52-[Q- <br /> PHONE <br /> 52ldPHONE (1): �,Dq` ,� •39 2,t) PHONE (2): -b31 J' FAX OR E-MAIL: cJG(11� QS'��>jYlgOi <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will cont to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE ri° �5 - 2_0`_+ <br /> 1. List up to ten addresses i are below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the a propriate box(es). At least one file type MUST be selected. Fax to (209)464-0138,mail to the <br /> address indicated below, or email to info(a)sicehd.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 below. <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$152 deposit prior to review. <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 FILE ADDRESS <br /> HEALTH DEPARTMENT ( P y 9 P ) E ,J D USE ON, LY <br /> FILES (Specific addresses only,address ranges will not be accepted) I <br /> Underground Tank(UST) Street# Street Name City <br /> OCleanup Site(LOP) W Q l on �I� CONSUMER <br /> ther Cleanup Site(Non-LOP) 13 l� -�� �,1 1 <br /> 7 Hazardous Waste <br /> ❑ DAIRY <br /> Tiered Permitted Facility2 <br /> n Aboveground Tank _ f <br /> E] UST (Monitoring/Removal) U I-� ❑PWS <br /> F34. ardous Materials 3 <br /> Spill/Release Response <br /> d Waste Facility/Vehicle 4 ATER QUALITY <br /> Food Facility <br /> of/Spa ITE MITIGATION <br /> VF-1 <br /> airy 5 <br /> a Use Application Sites <br /> eptic Pumper Truck/ s -USING <br /> /Chemical Toilets <br /> astewater Treatment Plant <br /> UPA <br /> sing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing <br /> stc�Tire 9 OLI-WASTE <br /> W <br /> Ni <br /> Complaint <br /> Fiher(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> i <br /> LORecords provided by Staff-PPR Complete. staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 IF 209 464-0138 1 www.sjcehd.com <br />