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i■ <br /> No. 3464 P. 1 <br /> �■ DAT _ _ EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> �■ - k 201i ENVIRONMENTAL HEALTH DEPARTMEN i <br /> ■ 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> t t�/IPtQt iTAL `one: (209)46M420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> —PEI•IMSEW�'.E3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ashlen MCG i Tinis BUSINESS/AGENCY; SJC Public Works <br /> ADDRESS: 1810 E. Ha elton Ave CITY/STATE/ZIP: Stockton, CA 95205 <br /> PHONE(1): 209-468-308t <br /> PHONE(2): FAX OR E-MAIL: 209-468-2-999 <br /> Please allow 10 usiness days from date of application submittal for the records to be available. <br /> Staff will conta you to arrange an appointment date and time to review the requested records, <br /> CHECK BOX TO EXPED E REQUEST-$139 FEE(CASH OR CHECK ONLY)__REQUEST PROCESSED IN 3 BUSINESS.DAYS <br /> SIGNATURE OF APPLICANT DATE Z 23 ( - <br /> 1. List up to ten addresses in t"space below. Select the type($)of files from the list below by checking the a 'propriate <br /> box(es). At least one file typb 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 applloant 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 accord'Ingly. <br /> 4. Any file not returned in the s me 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: ❑ List❑ Map-Description: 0 2 <br /> Specific Date Range of Inform tion Requested: From to <br /> ENVIRONMENTAL <br /> HEALTHDEPARTAAENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) rr I 1^I^ CONSWER <br /> OTHER CLEANUP SITE(Nowt-OP) ' (O J �V vl '"� <br /> Ea-f1AZARDous WASTE <br /> IEREO PERMITTED FACILITY 2 '� 5 vie <br /> e I m S� I A•/ /��n��� <br /> ABOVEGROUND TANK ULi <br /> `BUST (MONITORINQ/RFMOVAL)- � �gy {{ �✓ ❑PWS <br /> I�HAZARDOUS MATERIALS 3 00 S ce 11 orN D 1 . <br /> EfSPILL/RELEPSE RESPONSE <br /> H'80LID WASTE FACILITY/VEHICLE 4 j WATER QLULITY <br /> RooD FACILITY / <br /> POOL/SPA t) I Srre M171GATION <br /> ❑DAIRY 5 VI <br /> NAND USE APPLICATION SrTEu V1+(n W- 6 to <br /> ti B n <br /> i/1".PUMPER TRUCK/ �h 1 ,�I f! I _ U s7`4L 0 HouslN¢ <br /> YARD/CHEMICAL TOILETS W/ C'P-L'I"� h. ;A I / <br /> WASTEWATER TREATMENT PLANT _ IfV oCO <br /> 71 HOVSING ABATEMENT 7 Y W•� I ` —O of— D Ic 0 UPA P/�/V� ���J-�,'�'� <br /> MOTEUHoTEL 1 <br /> CNICKEN RANCH I DOG KENNEL CVPA-UST <br /> ❑MEDICAL,WASTE FACWTY 9 <br /> ❑TATTOO/BODY PIERCING <br /> I]WASTE TIRE 5CUP WAe7E <br /> 8 <br /> COMPL JNT <br /> OTHER(PLEABE SPECIFY). <br /> ❑ACCOUNTING <br /> 10 <br /> '-'HO�¢D AREA•EHD USE ONLY'•' <br /> 0 <br /> ❑ Records provided by tall-PPR Co Tete. serf Name= <br /> Received Time Feb, 23. 2013 . 04 M No, 0872 <br />