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4KE' h <br />pep • <br />EDepartment <br />n ental Health <br />SAN OAQUIN�� <br />COUNTY PUBLIC RECORDS RELEASE APPLICATION <br />civ <br />GSAL I <br />AtiPo� <br />Greatness grows he <br />OozqqIPEIIIR/5`� EHD LOG NUMBER: <br />APPLICANT: 7ohr /(-nnfcfV BUSINESS/AGENCY: I-IviI+1964DC,c.('CJ ),-7L. <br />ADDRESS: c/ iw y CITY/STATE/ZIP: g_�, O 14 44/ (4(o <br />PHONE (1): (4yo-2?2--9Gi-/.S PHONE (2): FAX OR E-MAIL: 1Le �1vf e Jy �(/►v ((I✓t�,cnrr, <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contactyou to arrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT c�10 L-- L- DATE M bll?, <br />1. List up to ten addresses in the space 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, mail to the <br />address indicated below, or email to info(cDsicehd.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 $152 deposit prior to review. '.' Lj <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) s <br />1 Electronic Information: I I List I I Mau - Description: , <br />Specific Date Range of Information Requested: From iFav It Cif aVGt I r.6 fe to M avCl-, 7-,612-0 ( 8 <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />only, address ranges will not <br />Y 9 <br />accepted) <br />be acce ted <br />EH USE ONLY <br />Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />I <br />IO <br />t7 <br />�v�` O� COwI' <br />{�lGfi i C <br />❑ CONSUMER <br />/o <br />Cleanup Site (LOP) <br />[Other Cleanup Site (Non -LOP) <br />Hazardous Waste <br />Tiered Permitted Facllity <br />SV'_ec Izte3 glLicj• <br />po a -14-'e cc. <br />DAIRY <br />® Aboveground Tanki <br />L 5 �. E • ti'v✓ <br />1"' <br />❑ PWS <br />UST (Monitoring / Remova <br />Hazardous Materials <br />3 <br />Spill / Release Response <br />4 <br />WATER QUALITY <br />Solid Waste Facility / Vehicle <br />Food Facility <br />S e MMGA11ON <br />r] Pool / Spa <br />❑ Dalry <br />5 <br />❑ Land Use Application Sites <br />ElHOUSING <br />Septic Pumper Truck /6 <br />Yard / Chemical Toilets <br />] Wastewater Treatment Plant <br />MICUPA <br />Housing Abatement <br />7 <br />AST/HM/HW <br />El Motel/Hotel <br />CUPA <br />n Chicken Ranch I Dog Kennel <br />Medical Waste Facility <br />6 <br />UST <br />F] Tattoo/Body Piercing <br />SOLID WASTE <br />WWaste Tire <br />y <br />F1 Complaint <br />❑ AccOUMWG <br />E] other (Please Specify): <br />10 <br />—BOXED AREA - EHD USE ONLY- <br />-�. <br />,c P }y'_ ,^,rr n. ! 61in It C -I . � t;. r A ;:•'$A, ¢ c w. Gl., ', <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 46-06 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />