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RECEVED <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN IOAQUIN COUNTY <br /> MAY 2 6 206 ENVIRONMENTAL HEALTH DEPARITM01*SH <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> MRONMENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> PERPAIT/SERViCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_A4(jk,-FA - 'TIL - BUSINESS/AGENCY: IANC! A-N ��F p,IELL q�UL1•D <br /> ADDRESS: Lf-l2 Z n J�A�n VAP L A,lbc S L)ITE 2-If CITY/STATE/ZIP: Sq.� ,7'L�('F�A �•t/! �- <br /> PHONE(1): PHONE(2)--6N- --QO�q FAX OR E-MAIL: {- u�,co <br /> Please allow 10 business days from date ation submittal for the records to ben -z- <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ER CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT MAA r� DATE Q5-(J--12-0 /-6 <br /> 1. List up 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$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to I <br /> ENVIRONMENTAL - 14 y 1 - <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> RIUNDEROROUND TANK(USTI Street# Street Name city <br /> �-CLEANUP SITE(LOP) <br /> TpSAI A-9-r, <br /> 1LLA <br /> CONSUMER <br /> OTHER CLEANUP SITE(Nom-LOP) 1 97� MAPLIP SA 14A-9 J57V 4 <br /> HAZARDOUS WASTE � vCAO <br /> a - <br /> C NU �l ❑DNH. <br /> TIERED PERMITTED FACNry 1 f 1 n np(,�}yk ✓J.. <br /> F�ASOVEGPOVNO TANK T 1 I✓I l� rw K-L/ <br /> UST (MONITORING I REMOVAL) W / ❑PWS <br /> HAZARDOUS MATERIALS S �/ 1 A/j y� (OQ(A �A�}A Si'lll C4,T A/ I �t <br /> ill SPILL/RELEASE RESPONSE 7�C (V If1 r'-' 1 Jrl (lJ .l 1✓L-f'�T �' p1 T L 1 Will / <br /> F1 SOLID WASTE FACILITY I VEHI 4 �. WATER Q.,", <br /> F1 FOOD FADIHTYC2S <br /> ❑POOL/SPA UsITE MITIGATION <br /> ❑DAIRY M Af-(Pos'A A;ADhj�//� I I2� <br /> E]LAND USE APPLICATION SITES A/ W <br /> ❑SEPTIC PUMPER TRUCK/ 6 G � /� HOJSNO L.Ay <br /> YARD I CHEMICAL TOILETS f� (P O�A <br /> �b /NTV t �YJ O d('9 TO <br /> 71 WASTEWATER TREATMENT PLANT <br /> CUPA <br /> ❑HOUSING AHATEM ENT _ L l l <br /> F-1 MOTEUHOTEL /-©® ^fj n_AD SWC-71)(V <br /> �j-�I�'g�� <br /> ❑(THICKEN RANCHI DOG KENNEL 6 c q .r�-, to 0z") PA-HAZ-MAT <br /> ❑MEDICAL WASTE FAc1uTY ,2,i]p( J Y 1 91 V(�[)Al � f I <br /> ❑TATTOO/BODY PIERCING <br /> F1WASTE TIRE 6 ❑$OLIO WAsiE <br /> ❑COMPLAINT S <br /> ❑OTHER(PLEASE SPECIFY): u <br /> Or 1 1 <br /> �� T <br /> 5V,1 :a4 I <br /> —BOXED AREA-EHD USE ONLY"' <br /> 5- e 23 MAu 1203k ;ntpb) <br /> - F r0AZ <br /> Staff-PPR <br /> EH048.06 tZ,y,J914..77 �. ,,, ,,,� �� M <br /> 2431 Ma(.v®5`�j, - a NO f M ,r� yea <br />