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VO/Ov// 4u� l(/Wcu 10::Qus� PrA OL% Quo LYLE invxzon 1nTernaLlonal Vo IOU V1/Vol <br /> gI' <br /> R E9EI ® I <br /> DATE RECEIVED 1i,�! EHO LOG NUMBER <br /> SAN JOAGIUIN COUNTY <br /> 1 AU J 2011 ENVIRONMENTAL HEALTH DEPARTMENT 7068 East Hazelton Avenue, Stockton, CA 95205-6232 7M2 <br /> EWROhfMEildALHI�Talephons:(209)468-3420 Fax: (209)464-0138 Web:wWw.SjOov.org/ehd <br /> PiapwrmERYM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AV.S$1A RaurISA&I BUSINESS/AGENCY; n4mw/ <br /> ADDRESS: S7 N'7 PePilmfatei' M'C CITY/STATE{ZIP: pvbl)n / Dtil4/y301'7 <br /> PHONE(1); PHONE(2): FAX ORE-MAIL: RtiPvns�ell�A rr~r,�6All. COwt <br /> Please allow 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 /> 0 CHECK BOX TO EXPEDITE ST-5139 FEE( OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE YI I20/'7 <br /> i. List un to ten addr sa ses In the space below. Select the type(s)of flies from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to f2.0.9)464-0138 or mail to the address indicated abovgb 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 flies axial. An appointment for review will be confirmed approximately tan (10) <br /> days after receipt of application. The fifes 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 0;00 AM•5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronla Information; ❑ List❑ Map—Description: <br /> Specific Dale Range of Information Requested: From 411 to <br /> ENVIRONMENTAL <br /> HEALTHRTMENT FILE ADDRESS <br /> FILESEHD USE ONLY <br /> UNOERCROUNOTANKIUST) Street q Street Name city <br /> CLEANUP SITE(LOP) _ <br /> ❑j Dl-;ye I l N 91 <br /> Cafiuu. <br /> OTHEACLEANUP SITE(NON-LOP) FD final Un C/ <br /> HAZARDOUS WASTE <br /> p ONRr <br /> Q TIERED PERMITTED FgDIL1iY ] <br /> ❑ANCVEGROUND TANK <br /> GUST (MONITORING/REMOVAL) PWS <br /> HATAROOUe MATSRIALB 5 <br /> &SPILL/RELEASE RESPONSE <br /> r7 SOLID WASTE FACIUTY/VEHICLE a WATEAeuNUI1 <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA 218111 MITIGATION <br /> ❑DAIRY E <br /> ❑LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK ❑komnr <br /> e <br /> YARD/CReMICaL To11.Ef6 <br /> ❑WASTEWATER TREATMENT PLANT Q CUPA <br /> ❑HOUSING AOATEMENT r <br /> r MOTELIHOIEL <br /> r7CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY $ <br /> ❑TATTOOMODY PIERCING <br /> WASTE TIRE <br /> e <br /> ❑COMPLAINT <br /> ❑OTIIER(PLEASE 6FECIEv): <br /> ❑AWOUNRNG <br /> 10 <br /> ^'BOXED AREA.ENO USE ONLY.. <br /> $ 3 l?• ;A J ono n ! (i:a ie�u , ;.�4�r cL a we 4; r Gt�M <br /> ,'. <br /> q n— o <br /> ❑ Records provided by Staff-PPR Complete, 6101 N0TIPD c ,+u LJfej <br /> END 48-00 <br /> Received Time Aug, 30. 2017 12: 36PM No. 2193 <br />