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-RECENED <br /> DATE RECEIVED 1� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAY 26 20% ENVIRONMENTAL HEALTH DEPARTM <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> a°�.rIRON'MENTAL HEALTH Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> PERFAIT/SEE VICES PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICANT:_ '(fir•TA - 7��-•T �( t _ BUSINESS/AGENCY: LA}Aj 44� 2k)cLL_ tA�at-t-D <br /> ADDRESS: 1)02 VAR k LI /c-. sty 1•PF 7 /(� CITY/STATE/ZIP: �J <br /> PHONE(1): (�"AGI(� tf( PHONE(2): SSR --- � FAX OR E-MAIL: <br /> Please allow 10 business days from date of a {. r� <br /> y p Ip cation submittal for the records to be avdilable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> Ux CHECK BOX TO EXPEDITE REQUEST-$130FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT MAA� t'p-E( DATE L9.,S-12,.6 12-0 1.4 <br /> 1. List UD 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. Fax 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 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$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to 4 <br /> ENVIRONMENTAL - Vtji JR37jor UZM un <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> Ii UNDERGROUNO TANK(UST) Street# Street Name City y� <br /> Y CLEANUP SUE(LOP) liul U / • �, CONsuMER <br /> 72 OTHER CLEANUP SITE(NON-LOP) N A3q-3 MAkI Fbsft ROAD S' cv_TvIV fA ' (j) <br /> 'RI HAZARDOUS WASTE A .1 C •� ;�. ONHx <br /> I�TIERED PERMITTED FACILITY R _//� .l A A-p r'0.{A_ ✓/ LTO f r47V_1 N <br /> 111�,vvvfff-ABOVEGROUND TANK �lT l✓IYTI` r�lr F-V([4411-- [.I�' IV <br /> I/y UST (MONITORING/REMOVAL) /. 5>" ❑PWS <br /> 'YrQ-''!`HAZARDOUS MATERAW ' ) 3 Z MA-f__I POSA &Ar> S7VCt-T9f\/ <br /> r.7I SPIU/RELEASE RESPONSE _ WwTEa pugLltt I <br /> ❑SOUD WASTE FACIUW r VEHICAE d <br /> M FOOD FACILITY POOL/SPA /�.`t/_J\ <br /> II <br /> ❑DAIRY 6 As1MAf-i1P©sK kAD S-j-DC Vr4 �f1� Q•SNE MRIGAIroH <br /> LAND USEAPPUCATION SITES SEPTIC PUMPETRUCK .tit�{ HousIHV yA} <br /> YARDICHEMIC LTOILE fi F IV-f(QrA 4AP S���/ IaO �� Iu� rel! <br /> YARD/CHEMICAL TOILETS r� /"1 ISI_`•'// <br /> ❑WASTEWATER TREATMENT PLANT 1,h_ /l El COPA <br /> n HOUSING ABATEMENT T M41 r ©®M/S &� (Toa_-m-I <br /> F1 MOTEUHOTEL bb L .? („IL- YY I <br /> E]CHICKEN RANCH/DOG KENNEL _ /,I/9 O .r PA-HAZ-MAT <br /> MEDICAL WASTE FACIDIY pZ•/(J J <br /> E]TATTOOMODY PIERCING D$pLID WAsiF <br /> WASTE TIRE 9 I <br /> ❑COMPLAINT Addz C,�^. ( • _4 '(n��" <br /> OTHERIPLEASE SPECT%J: _ J 1 � O n T•,4L u /!� N/13/I S G(j/,ywn � +49 <br /> tD <br /> •"BOXED AREA.EHD USE ONLY*** <br /> 5- e / a 3 Sa- n 106 <br /> t Fie / 0 �Oz <br /> fit I I s� r 46 ; <br /> e!� Staff-RPR �ete ��,L� �S /' <br /> EHDAB.Dfi W E YY ' aye1/1 lY`G /'r !j - 3Ljbq YNM'11� hE'Gl <br />