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EIVED <br /> SAN J Q ��. '1 r- 20,E Environmental It Department <br /> C; i� 1 1, x PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRONMENTAL <br /> PER ITJSERVI i By EMAIL { .I (; ? <br /> EHD LOG NUMBER: <br /> APPLICANT heE ecco tlatas BUSINESSIAGENCY.Advacce,d GeuE o w,,cn,tai <br /> ADDRESS: CITYISTATE/ZIP:Steckt} `oztF <br /> PHONE(1): 209-467-1f)66 PHONE(2):�0,9 62 ,Uj FAX OR E-MAIL: r ', t dYc, crr torr <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 /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> address indicated below,or email to info@sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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. f ,1 <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS - ' '� 1�1 <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY addresses only,address ran es will not be ecce ted <br /> underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) 931 E OakfiStockton <br /> F]C•ansAJrden <br /> ®Other Cleanup Site(Non-LOP) <br /> ®Hazardous Waste r� Uj1 ❑DnrTY <br /> 1 722 E Flora t Stockton <br /> ® Tiered Permitted f=acility <br /> I <br /> Q Aboveground Tank — <br /> El <br /> UST (Monitoring/Removal) ( Fremont °} �^+ } y PWS <br /> ®Hazardous Materials E:t <br /> `�903 a�7 ockto t <br /> 7, �� <br /> ®Spill 1 Release ResponseL_ <br /> Wqk WATER{QUALITY <br /> Solid Waste Facility lVehicle 4 1960 Fremont m0 1t 5. Stockton <br /> F]Food Facility <br /> Pool 1 Spa I it iAwl <br /> Mn;aaTiun <br /> El Dairy 5 1908 E Fremont St Stockton <br /> ®Land Use Application Sites <br /> �Septic Pumper Truck/ g 2p'}p' 1 E Fremont St :��q <br /> Yard 1 Chemical Toilets 1vJld <br /> ®Wastewater Treatment Plant Nit tUJ iitic;� NUPA <br /> E]Housing Abatement 7 2010 E Fremont St Stockton AST/HM/HW <br /> ❑ Motel/Hotel i <br /> El Chicken Ranch 1 Dog Kennel 11111 `al CUIPA <br /> Medical Waste Facility <br /> 2949 E Fremont St Stockton UST <br /> Tattoolbody Piercing — -- �. --- —_ O SOLID VV­s s <br /> E]Waste Tire g <br /> Complaint _ <br /> Other(Please Specify): ❑AccourriNc <br /> 14 <br /> —BOXED AREA-EHD USE ONLY— <br /> ��`I '. L rhe Ali') n : ac v '" "A$ u a4- aevtx 6 <br /> O Records provided by Staff-PPR Complete. staff Name: EHo 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br />