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CIPgUIry ly. <br /> SAKOOAOUIN �wd Environmental Health Department <br /> —COUNTY— 4'7- PUBLIC RECORDS RELEASE APPLICATION <br /> -P` Greatness grows here. Q <br /> EHD LOG NUMBER: <br /> APPLICANT: Cl]ee)f 3e"vtc4s 05"nf• BUSINESS/AGENCY: auertpscpD.v� *�rvt'trs <br /> ADDRESS: q GOO os e W Ik Ili ouek D CITY/STATE/ZIP: /Up/'4A F}� <br /> PHONE(1): -103 b PHONE (2): FAX OR E-MAIL: <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 un 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(Msicehd.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. <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) /D/d <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> R1 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LDP) L�tV �� w fvck� ffiGoasumea <br /> At Other Cleanup Site(Non-LOP) aa�s �►• J <br /> RJ Hazardous Waste <br /> [jrOAIR <br /> Tiered Permitted Facilely <br /> Aboveground Tank _ <br /> LT UST (Monitoring/Removal) <br /> PWS <br /> 2q Hazardous Materials 3 <br /> gj Spill/Release Response <br /> rel Solid Waste Facility/Vehicle 4 t�Waee goaury <br /> la Food Facility <br /> Pool/Spa ASITE MITIGAneN <br /> Dairy 6 <br /> Land Use Application Sites <br /> Septic Pumper Truck/ [6}Houslrvc <br /> 6 <br /> Yard/Chemical Toilets <br /> Ja Waslewaler Treatment Plant CUPA <br /> I`I Housing Abatement T AST IHIM/HW <br /> Jj],Motel/Hotel <br /> Chicken Ranch/Dog Kennel QCUPA <br /> .Medical Waste Facility UST <br /> Tattoo/Body Piercing $g SOLD WASTE <br /> Waste Tire g <br /> ©Complaint <br /> Other(Please Specify): [dAccouw1w <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> 00 Co t'Z <br /> Co 1 <br /> ❑ Records prov ded by Staff-PPR Complete. staff Name: L EHD4a-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 />