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DO No-r &"Ve <br /> DATEERE'CFIVE) SAN.IOAS.)UIN COU �/e / EHD LOG NUMBER <br /> I <br /> JUN 16 2063 ENVIRONMENTAL HEALTH DEPARTMAT t � <br /> 1868 East Hazelton Avenue,Stockton,CA 45205-6232 - <br /> E1NV1R=NrAEfef!t6 l-' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> n Pr`i ITISE '6`i= ==- <br /> APPLICANT �� ..�� �` ti "I a r. r � <br /> SINES/Af�EFiCY: ������f..l�,�.�1� C:; /tic <br /> t <br /> ADDRESS: Ef _I a tSTATEt�IF: o? <br /> PHONE(1): C i� PHOME(2): FAX OR E Li ir—n In If <br /> Plaase:linw 10 buginess days from date of application submittal for the reco ail �. <br /> Staff will contact to <br /> t I ntact 3 u to arrange an appointment date and time to review theFq]i cor s. <br /> ❑CHECK BOX TO EXP ).TE,,"REQUEST-�$ 30 FEE(CASA OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses In the space low. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail 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 it any EHD Tiles 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 clays 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$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM--5:68PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List 0 Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL m <br /> I4EALTE 8 DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILESUNDERGROUNDTANK(UST) Street Street Flame City ff <br /> --- CLEANUP SITE(LOP) . ffCON°UMER f! <br /> �PTHEA CLEANUP SITE(NON-LOP) <br /> HAzAnous WASTE <br /> [i GAMY <br /> -' <br /> fj�TI <br /> PERMITT-=D FACILITY <br /> 'ABOVEGK ROUND TANt . <br /> BUST(MONITORING 1 REMOVAL) - I j 0 P"'s <br /> t� G <br /> HAZARDOUS MATERIALS I_ /V/K� j?j Vd, /(i�� <br /> SPIWRELEASE RESPONSE r � l <br /> ��,//SOLID WASTE FACILITY I VEHICLE /T7�.`� �,T-/ WATEdt CIUtJTY <br /> j�FOOD FACILITY 35D Ad <br /> ,J,y n f (,j•L 1/ ;I <br /> /❑POOL!SPA [`SITE M�IT4ATty oN `(J( <br /> DAIRY i ti 17"- <br /> LAND <br /> LAND USE APPLICATION SITES ' <br /> SEPTIC PUMPER TRUCK/ HouslNo - <br /> e <br /> ,J�YARD/CHEMICAL TOILETS <br /> ►j� ETS I <br /> WASTEWATER TREATMENT PLANT CUPA <br /> P❑�HWSING ABATEMENT 7 <br /> 0 MoMtHOTEL i i lam•A A 9 F,��,i I�.,e i E . <br /> CHICKEN RANCH I DOG KENNEL <br /> vT BUPA-HAZ-MAT } <br /> 1]MEDICAL WASTE FACILITY <br /> 171 TATTOOIBODY PIERCING •N Ll/ LJ (25 in Wts <br /> WASTE TIRE l �/'� (1 <br /> ❑COMPLAINT �I/ L. L" u F O i`Y1j �VJ <br /> OTHER(PLEASE SPECIFY): Q A=uNTtNQ <br /> 1fav 7' <br /> -BOXE EA-EHD USE ONLY"' <br /> © Records provided by Staff-PPR CoMplete.staff isiams: <br /> £HU".06 <br />