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'RECEIVED <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN I (• 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 15 4 UP <br /> Pf(�t+lilt �fRi l ' -TI-B Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> J!Wmt rrfsEVM2 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �ti�� /�ac%r1i �+ BUS[NESSIAGENCY: <br /> ADDRESS; ���� S;'g,, ;/ [:} CCrrtf..c, G� CITYISTATEIZIP: <br /> PHONE(1): 2 5�70, ? PHONE(2): FAX OR E-MAIL: /YJCr/'L l)u�X12- r l i{ift17a;�.Gr , <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 /> ❑CHECK BOX TO EXPEDITE REQU T-$139FEE(C OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the sp cc bel elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST b lected. 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS FILES EHD USE ONLY <br /> p <br /> UNDERGROUND TANK GUST)[ Street Street Name City <br /> CLEANUP SITE(LOVJvpi v`!. CONSUMER <br /> y I OTHER CLEANUP SITE(IVO •tl , T I�17o 1? <br /> HAZARDOUS WASTE V Jl <br /> �-{ c`�,, DAIRY 2 <br /> I/I TIERED PERMITTED FACILRY` /Z t ` Y <br /> PABOVEGROUND TANK O' -V <br /> .�5 UST(MONITORING/REMOVAL) <br /> PWS <br /> HAURDOUS MATERIALS <br /> 1V--SII—'SPILL/RELEASE RESPONSE <br /> SOLID WASTE FACILITY I VEHICLE WATER QUALITY <br /> 4 <br /> FOOD FACILITY <br /> POOL I SPA fA SITE MITIGAToN <br /> DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK 1 0 HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS " <br /> WASTEWATER TREATMENT PLANT <br /> CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY B <br /> TATTOO/BODy PIERCING <br /> SCUD WASTE <br /> WASTE TIRE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> n 70 <br /> i� <br /> -BOXED AREA-EHD USE ONLY— <br /> CAWr Y <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-H <br />