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Kyle JUAQUI Environ menta0 Health Department <br /> r. <br /> ASR 1 �W <br /> OU NTY PUBLIC RECORDS RELEASE APPLICATION <br /> EfMR0WEkAL14IIrAL5fHyrcv,,S here U \� �(J I <br /> i�ERMIT/SERVICES EHD LOG NUMBER: `l <br /> n ��EUSCI� <br /> PPLICANCY: <br /> RUIZIP• DDESE ; <br /> Zo <br /> PHONE (1): Z PHONE (2): 'meq—35T—25Zoe? FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be aval able. <br /> Staff will contact you toarran a an appointment date and time to review the requested a ords <br /> SIGNATURE OF APPLICANT/� ( / DATE <br /> 1. List up to ten addresses in the space below. Address ranges accepted. Select the type(s) 6f 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(a)slcehd.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) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y 8 accepted) EHD USE ONLY <br /> FILES (Specific addresses only, address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) 64. SUMER <br /> �vOther Cleanup Site(Non-LOP g�� (,�-/uia✓\ � G�'�/� <br /> 12rHazardous Waste 5�I I,.I"(',Hr"t,la WI�lbT, AIRv <br /> Tiered Permitted Facility 2 t iyl� Y e <br /> [Aboveground Tank ` <br /> � <br /> Ig UST (MonHoring/Removal) [j PWS <br /> Hazardous Materials a <br /> ('Spill I Release Response AreR Quem. <br /> ldsolid Waste Facility/Vehicle q <br /> Food Facility Q_ AILS, WU1411140^12 <br /> Q Pool/Spa (' ��`) SnE MhNGAnoN <br /> Dairy 6 <br /> Land Use Application Sites \ MOUSING <br /> Septic Pumper Truck/ 6 <br /> Yard I Chemical Toilets I I W <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement y AST/HM/HW <br /> Motel/Hotel <br /> CUPA <br /> [/Chicken Ranch/Dog Kennel <br /> g UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing Nrsm.WASTE <br /> Waste Tire e <br /> Complaint <br /> Other IPlease Specify): L]Acc.axnxs <br /> to <br /> ***BOXED AREA-EHD USE ONLY**" <br /> ❑ Records provided by Staff-PPR Complete. sfxtf Name: aHo as-os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcelid.com <br />