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SANJOAQUIN <br />i COUNTY-- <br />:iii¢ICXc`i' Greotness grows here <br />•APPLICANT: <br />ADDRESS: <br />PHONE] <br />F__ <br />SIGNATURE OF <br />1. List uo to to <br />1'' CtVtIVWronmentaa Heallth Depertmerk <br />MAR 0 7 209th <br />ENVIRONMENTAL HEALTH <br />F91aPItm <br />Please allow 10 business days from date of <br />Staff will cork ct,you to pj�tment date and time to review the requested records. <br />DATE ,j''"� ✓6 <br />PUBLIC RECORDS RELEASE APPLICATION <br />FHn I nr NI IMRFR• 001P <br />CITY/STATE/ZIP: &-rk <br /> FAX OR E-MAIL: <br />for the records to be available. <br />box(es). <br />ranges WILL NOT be accepted. Select the type(s) of files from the <br />st one file type MUST be selected. Fax to (209) 464-0138, mail to the <br />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. <br />Future file reviews by the same applicant may require a $152 deposit prior to review. 3/9 <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 <br />HEALTH DEPARTMENT <br />Specific <br />FILE ADDRESS <br />be <br />EHD USE ONLY <br />FILES <br />(addresses <br />only, address ranges will not <br />accepted ) <br />qq /y <br />OC '/ i8 <br />N Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />f <br />�'� <br />t L MtL <br />q <br />` _)3 A 5! ) I <br />-s i'n t'tl o <br />Cleanup Site (LOP) <br />® Other Cleanup Site (Non -LOP) <br />� Hazardous Waste <br />I �n <br />%+_ <br />�{ /n �P; S m U�/r'�^ r <br />Tiered Permitted Facility <br />2 <br />//4'%✓l�'�'VV <br />/�/nom\ <br />AlA <br />_ ��,� f <br />'1�®v <br />�r/t�iv <br />AV0TS O QWa" 75 `Y <br />E] Aboveground Tank <br />// <br />1 <br />a <br />MOP �LLYC�/RA_VL_ieeA_ Reqw <br />F1 UST (Monitoring /Removal),1114 <br />fA Hazardous Materials <br />3C3 <br />"V <br />❑ Spill/ Release Response <br />WATER QaALIV <br />Solid Waste Facility /Vehicle <br />q <br />Food Facility <br />Ci�trni MmcAnoN <br />Pool / Spa <br />Dairy <br />5 <br />Land Use Application Sites <br />[j HousiNc <br />Septic Pumper Truck / <br />6 <br />Yard / Chemical Toilets <br />Wastewater Treatment Plant <br />CUPA <br />Housing Abatement <br />r <br />ASTI HM/HW <br />Motel/Hotel <br />❑ CUPA <br />F1 Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />a <br />UST <br />Taaoo/Body Piercing <br />E] SOLID WAare <br />�] Waste Tire <br />a <br />F1 Complaint <br />❑ AccouNmNa <br />Other (Please Specify): <br />1R <br />'—t3U7,tU AKtA - 1=HU UJt UNLT' <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjoehd.com <br />�Q <br />f <br />