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RECEIVED <br /> DATER E • SAN.IOAQUIN COUNTY FIL �EH R <br /> Gifq_ <br /> 9 2016 �i.. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> il��� <br /> tAL HEM3141868 East Hazelton Avenue, Stockton, CA 95205-6232 i <br /> Telephone:(209)468-3420 Fax:(209)464PM <br /> -0138 Web:www.sjgov,org/ehd "7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 2 S !�)ATti�S q;7,1. I.�G ,� 3$� CITY/STATE/ZIP: s'�FG>?knvft•c b c,k��S 33 <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: <br /> Pleased w 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'FJCPEDIT_ E ES7. $139 FEE(CASH,OR CHECK 0NLY).;REQUEST PROCESSED.IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1,1I l I-I I6 I <br /> 1. List up to ten addresses in the space be ow. 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(209)464-0138 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 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 RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: W List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> i <br /> ENVIRONMENTAL <br /> HEALTFI>bEFARTMENT FILE ADDRESS <br /> -TIES EHD USE ONLY <br /> /UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) /,"J 1 1-1 CONSUMER <br /> THER CLEANUP SITE(NON-LOP6 <br /> AZARDOUS WASTE `t . . WLDt Jy "44 .( ' <br /> DAIRY v <br /> I <br /> TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> ❑GUST (MONITORING/REMOVAL) PWS i <br /> �FtAZARDOUS MATERIALS 3 <br /> SPILURELEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY)VEHICLE 4 <br /> ❑FOOD FACILITY { <br /> ❑POOL/SPA SITE MITIGATION 1 <br /> ❑DAIRY B <br /> 1 <br /> ry❑I LAND USE APPLICATION SITES <br /> Icy SEPTIC PUMPER TRUCK/ HOUSING <br /> YARD/CHEMICAL TOILETS <br /> i <br /> WASTEWATER TREATMENT PLANT <br /> CUPA I <br /> HOUSING ABATEMENT <br /> ❑MOTEUHOTEL <br /> i <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> I <br /> MEDICAL WASTE FACILITY B <br /> ❑TATTOO/BODY PIERCING <br /> ❑WASTE TIREa Mf SOLID WASTE <br /> ❑ B ` t <br /> COMPLAINT UlV•�:L„�it <br /> ❑OTHER(PLEASE SPECIFY); ACCOUNTING <br /> 10 f� <br /> —BOXED AREA-EHD USE ONLY"' 1 <br /> I <br /> i <br /> i <br /> I <br /> ❑ Records provided by Staff-PPR Complete.Staff Name; � <br /> EHD 48-06 <br />