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From:5103383192 <br />.RECEIVED <br />DATE RECEIVED <br />SEP Q 7 201? <br />Ei %)U1 L WQ."j <br />PERlW/SffMiX9 <br />09/07/2,01r'7s1 <br />FILE "� <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: ahs I e_h <br />ADDRESS: S2o 3' S <br />#575 P.001/001 <br />EHD LOG NUMBER <br />Q>7o'iq <br />_BUSINESS/AGENCY: 4 Et C o&i S k l I g n S <br />CITY/STATEIZIP: o,kta-d / C fl- / q 4-6 d _-3- <br />PHONE (1): 2_t+o - 74-5'2 - 2 o -�- q PHONE (2): _SIy - qD�- - 31 qS FAX OR E-MAIL: 'I <br />kpY%koa; a, Aei oohst, ( f AA1 s -Go r <br />Please allow 10 business days from date of application submittal for the records to be available. i=Ax : 5'f o - 338 - 319 <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />EICHECK BOX TO EXPEDITE REQUEST- $139 FEE (CASH OR CHECK ONLY) `-. REQUEST:PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE i / 77- // 7-- <br />1. List up to ten addresses in lye space below. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At least one file ty#e 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 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 fivA business days for review. Appointments <br />should be scheduled accordingly. <br />4. Any file not returned in the same condition as released will b eorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $1 deposit prior to review. 15 <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR EVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: K List [4 Map - Description: <br />Specific Date Range of Information Requested: From 01 a t $ to c v, vv 4A, -t <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />5UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />P <br />6 <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />HAZARDOUS WASTE <br />YTIERED PERMITTED FACILITY <br />yABOVEGROUND <br />2 <br />9 \N <br />G�bAIRY <br />TANK <br />rST (MONITORING/REMOVAL) <br />!UO <br />74v <br />d7..1/10 <br />� PWS <br />YHAZARDOUS MATERIALS <br />✓ <br />bAj�r0r9SPILURELEASE <br />RESPONSE <br />ffs -o WASTE FACILITY / VEHICLE <br />I1 � <br />(�0aa <br />/jA({1yo .r <br />WATER QUALITY <br />FOODFAauTv <br />I <br />GIVW�U�� <br />I/� 1 POOL / SPA <br />W-flTE MRIGATION <br />DAIRY <br />5 <br />LAND USE APPLICATION SITES <br />�HOUSWG <br />SEPTIC PUMPER TRUCK / <br />YARD / CHEWCAL TOILETS <br />6 <br />WASTEWATER TREATMENT PLANT <br />9ffHOUSIABATEMENT <br />tf CUPA <br />T <br />L'�'If�;T <br />MO7EUHOTEL <br />CHICKEN RANCH I DOG KENNEL <br />OCLIPA- UST <br />MEDICAL WASTE FACILITY <br />B <br />04 <br />TATTOO/BODY PIERCING <br />ouo WASTE <br />WASTE TIRE <br />iy{ COMPLAINT <br />❑"'CCC OTHER(PLEASE SPECIFY): <br />ACCOUN71N0 <br />10 <br />—BOXED AREA - EHD USE ONLY— <br />(A-7-1� r:l � .:(y'Ti^l �r .,/'a''1 Le'. ii"fe- d� 4V� A �.i"�' I~ �t�. ('✓ t�4:i �!..�` t—t "�. L� <br />4 <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />EHD 4B-06 <br />Received Time Sep. 7, 2017 12:44PM No,2245 <br />