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ECEIVED <br /> DATE RECEIVED �y S N JOAQUIN COUNTY <br /> t 1 j 2011 EHD LOG NUMBER <br /> LUI ENVIRONENTAL HEALTH DEPARTMENT <br /> RONKIM-AL H�-NUM 1868 East Haz Iton Avenue,Stockton, CA 95205-6232 90 ,92 <br /> - PEIIIAITISER, ,0 Telephone:(209)468-34 0 Fax:(209)464-0138 Web:www.sjgov,org/ehd <br /> PUBLIC RE5( <br /> C RDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDREESS: 13 I_ S� w St cry vre� a� C-A f'I SS I L) CITY/STATEIZIP: <br /> PHONE(1): qlb PHON (2): 91A-R3S ,j36S FAX OR E-MAIL:„",,i; AartrtrGs:,�oyati <br /> Please allow 10 business days fromate of application submittal for the records to be available. <br /> Staff will contact you to arrange an ppointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE bREQUSTA$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT- <br /> DATE x�/p•)7 <br /> 1. List up to ten addresses In space below. Sel ct the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file ty0b MUST be selected Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications receiv d 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 re eased will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may reuire 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: Fr�m to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY 2122 <br /> fZ UNDERGROUND TANK(UST) Street# S�reet Name City I <br /> �yCLEANUP SITE(LOP) J�^{�i r O CONSUMER <br /> WI�q OTHER CLEANUP SITE(NON-LOP) 1 11-I Dr• �� ��� S'}'bU I`-I y�~ ✓ �/ <br /> I5 HA2ARDOUS WASTE j DAIRY <br /> ®TIERED PERMITTED FACI y --, /') I�(• �c. ��' til"' • vT <br /> ABOVEGROUND TANK <br /> UST (MONITORING I R V, e4lp <br /> (�L 11^ icy- <br /> SPILL/RELEASE <br /> SLS L O 1 C�# pWS <br /> CgHAZAROOUs MATERIALS 3 \ S� I. cc Ili I er <br /> 1 / l <br /> SPILURELEASE RESPONSE �y <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> 31 `�' L�WATER QUALITY <br /> n FOOD FACILITY <br /> t"L <br /> POOL/SPA SITE MITIGATION <br /> DAIRY 5 g�S clk.1 <br /> LAND USE APPLICATION SITES <br /> IJ SEPTIC PUMPER TRUCK I �$05 t 'r\r Ma ,r x�v.q L 0 �7 ❑HaISMO <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT ! y+ .}1 <br /> CUPA <br /> HOUSING ABATEMENT T t�^ t 11r�.p�'{�►��_�"`G� �` �} --_('7 f� ,����,,�y� <br /> MOTELIHOTEL h\ r 'v ,I ••14b L �O� ._., 'V V V r— <br /> CHICKEN RANCH/DOG KENNEL t1r � .tr W��CvN` ^)1CUPA-UST <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE <br /> �� t 1 SOLID WASTE I ✓ <br /> 5 1Vµ� lam.-l1 <br /> COMPLAINT 9 loth <br /> OTHER(PLEASE SPECIFY): O <br /> �y 0• 4 H'wl Acc G <br /> 10 <br /> XED AREA-EHD US N <br /> UI ;,� ink' <br /> 1ck'T07 t �S o <br /> s.d ('e—s <br /> Records provided by Staff-PPR Comolleete. ff Narni. �r/' /1 <br /> EHD 48-0 ,.J rl/ 60 <br /> /ISI 'S��'I`�' <br /> �rbV�7IIL,IJ //1 4V 4 <br /> 00+ 3 (n Heti di I- <br /> c,0 ft -,55, 6 w- Co 't 336 6 9, UJ - r 5 as U\-Pv� cs�) <br />