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E G E IVE D EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1:(2 East Hazelton Avenue, Stockton, CA 95205-6232.sjg5 4 NP <br /> [! VMRONW_NT�L TH Telephone:(209)d68-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PIEWTISM- I m PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1tiIsl,Z� N :tip=; _ BUSINESSIAGENCY: <br /> ADDRESS; =)L. _Sf'n:T / ,^} ([%•-I;..'e� / CITYISTATE/ZIP: <br /> PHONE(1): "? -7t'9 c? ?`% PHONE(2): FAX ORE-MAIL: /Y74 A'L_�lu, �f2;" o,l ir;trr70,�.C� <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 REOU T-5139 FEE(CABfl OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE j-/S_-)-7 <br /> 1. List up to ten addresses in the sp ce bel elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST berilected. 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: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From C;;/ to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS _ <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) street It Street Name City <br /> CLEANUP SITE(1-0111 <br /> 6 A `� ❑CDnsUMER <br /> \T 1 / <br /> OTHER CLEANUP SITE(N Nf IL )G W2 j{ '�1 U�L. I�;;fClif l C <br /> / HAZARDOUS WASTE �c`y / / pAinv •��„U <br /> I/I TIERED PERMITTED FACILITY <br /> P� ABOVEGROUNDTANK <br /> I/II–'UST(MONITORING/REMOVAL) El WS <br /> 14AZARDOUS MATERIALS <br /> I/I SPILURELEASE RESPONSE <br /> !--' CSI WATE>QUALITY <br /> SOl ID WASTE FACILITY 1 VEHICLE 4 <br /> FOOD FACILITY <br /> PO01.f SPA SITE MInGATUN <br /> ❑CA— 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ HotrslN� <br /> 6 <br /> YmD/CHEMICAL TOILETS / <br /> WASTEWATER TREATMENT PUNT GjCUPA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY 6 <br /> TATTOOWDY PIERCING <br /> SDUG l' sw <br /> WASTE TIRE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACC.U!1'INC. <br /> ] 1 70 <br /> 1 <br /> /I U ^'f30xED AREA-EHD USE ONLY"' Ar <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />