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urt et Vt,u� H <br /> ' SAM JOAQUIM GOCOUNTYEHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH on, CA <br /> Qr/y/jam <br /> JUN 2d L�F�i �1Ar�� "1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wv✓w.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICRTPOE,I <br /> ' PLICANT: C�aK.%IVGi (�Vr.%if�%��� BUSINESSIAGEMCY: �iC7t.;/�Ir,,:� <br /> ADDRESS: CITY/STATE/ZfP: .S.�:.tzr:;:�-„TJX G� �iE�SIL{ <br /> PHOHE (1): (Gllc i 1( —Cv� PHONE —vl -1 <br /> I E (Z): FAX OR E-MAIL:,-' I� )'f-=,,.- _,„J. <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List ug to ten addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Far,to (209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted.Applications received 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 cond'tion 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$130 deposit prior to review. <br /> VVELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOP.REVIEW: IAONDAY-FRIDAY 8:00 AM-5:001310 (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL I <br /> II HEALTH DEPARTMENT FELE ADDRESS I yCo rV atelt L40/ a �I I <br /> FILES EH USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) �^t�� /��/��jA/ �CONa11MER <br /> )THER CLEANUP SITE(NON-LOP) <br /> "�(�� llV• I g� ILII /Wd�D, N✓W/� <br /> AZARDOUS WASTE <br /> DAIRY <br /> TIERED PERMnTED FACILITY 2 ((� I llv Ong I ndl <br /> ®ABOVEGROUND TANK D (�Y(t% Wt� Lo <br /> dl* <br /> I'M DHrtDRIHD/ReaDva) , ❑PWS <br /> II HAZARDOUS MATERIALS G J� Ou Lob <br /> gL SPILLIRELEASE RESPONSE fV 1 [WATER Ouu.lTv h <br /> f1l SOLID WASTE FACILITY/VEHICLE 4 �1 1 ,l� V / <br /> M FOOD FACILITY t iArL <br /> 7 POOL/SPA SITE MMGATION <br /> DAIRY 6 '�VIOy rf f� <br /> Im�LAND USE APPLICATION SITES lLlllll.���1���•�`��� 1 D-� <br /> .I SEPTIC PUMPER TRUCK/ ❑Housum <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT P1 <br /> /C�/("f��k _ L./�t/�•�tl <br /> / <br /> CUPA <br /> HOUSING ABATEMENT1'� <br /> L-0 66 <br /> FjMOTEUHOTEL <br /> F-]CHICKENRANCH/DOG KENN '� CUPA-HAZ-MAT <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING SOUR WASTE <br /> WASTE TE <br /> COMPLANT1, 0? <br /> OTHER(PLEASE SPECIFY): ve � E]ACCOUNTING <br /> 20 o To <br /> Loin <br /> —BOXED AREA-EHD USE ONLY'^ <br /> 171. <br /> ❑ Records provided by Staff-PPR Complete. staff Nam: <br /> EHD 48-06 <br />