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' <br /> 6 � ��� " Hreaftn Department <br /> t <br /> ---(�{]UNTY-/�� -- PUBLIC RE �DS RELEASE APPLICATION <br /> ` <br /> ' <br /> APPLICANT: <br /> ADDRESS: CITYISTATE/ZIP: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contaept <br /> .Yu to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT P- DATE <br /> 1. List up to ten addresses in,4h space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking thevappropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138, mail to the <br /> address indicated below, or ernail to info(cD-sicehd.com. Applications will <br /> business day. <br /> _ For assistance — identifying the nature_and content_ —_ records, please contact—_ -'the � �. <br /> 3. The EHD*U| not�ythe applicant�any EHDfUesox�t Anappointment for review wiUboconfnmoapp��im�op�t�n (/v/ � <br /> days after receipt ofapplication. The files will beheld for amaximum offive business days for review. Appointments <br /> should boscheduled 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 /> ---° ' <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. I <br /> / <br /> SEPTIC AND WELL PERMITS ARE AVAILABLE FOR REVIEW ONLINE AT: h#ps:0vmmw.sjgov.org/departmentlenvhea|th/pub|in'mcordo ' <br /> Electronic information: F1 List El Map— Description: <br /> Specific Date Range ofInformation Requested: From t <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) SZONSUMER <br /> Other cleanup Site(Non-LOP) <br /> Hazardous Waste 19-6AIRYA Tiered Permitted Facilit (1 2Aboveground Tan <br /> I f Hazardous Materials <br /> 0 Spill)Release Response <br /> -7111 FS;ZZ QUALITY <br /> -9-Solid Waste Facility/Vehicle 4 <br /> Land Use Application Sites <br /> HOUSING <br /> Septic Pumper Truck 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plan rvj"C U PA <br /> NJ E]SOLID WASTE <br /> Waste Tire 9 <br /> her P111 Sipecify) V <br /> E]AcCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY <br /> El Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />