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G � ftw SANJOAQCOUNTY EHD LOG NUMBER <br /> DATE RECEIVED <br /> HEALTH <br /> ENVIRONMENTAL Ile'ALTH DEARTM C ' <br /> 1668 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> iROfZfEl`fT -� �,.{ Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> PERMITfSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_/�./Ir ,)'74 PLF'T I I _ BUSINESSIAGENCY.�fthlC rFFfl 1(�,�(-IJ�wU L <br /> ADDRESS: Lt -) ' n M nO9 V CI7YISTATEIZIP: SLkJ �2rf�_( �f L} <br /> PHONE(1): �-f-(S'- -Gl C ��L f-f PHONE(2): -OD�`� FAX OR E-MAIL: n _ {- � L^r'cin.CoP <br /> Please allow 10 business days from date of app kation submittal for the records to In av ilable, <br /> Staff will contact you to arrange an appointment date and time to reviewthe requested records. <br /> ER CHECK BOX TO EXPEDITE REQUEST-$130 pFFEE�(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT MAA . / c'-V DATEC95-1Z6-12_0 /-6 <br /> 1. List up to ten addresses in the space below. Select the iype(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091 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 <br /> ENVIRONMENTAL - 14 ""7 /' <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> 14UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP anE(LOP) A , ftL Ug L �, CONSUNEa <br /> SNCIc7vN <br /> 'rJ)OTNEN CLEANUP Sm(NON-LOP) <br /> HA RDOUS WASTE /� <br /> I�TIERED PERMDTEO FACIIRY 1 /r/31 MAP I`b- k ✓� + A_� �'��'�' (J V 1 ' <br /> TRASOVEGROUND TANK KT ,✓/ L` rtl+ F'L/1T 444111 __- E•M1 !J 0PWS <br /> ,}lL(Pp�IUST (MONITORING I REMOVAL) <br /> }CXZ^II HAlRDOUS MATEWALS I 1 &J( O- I PSA ®® AD- (y <br /> SPILLIRELEASE RESPONSE I /I <br /> GiWATER C)." <br /> Y❑'SOLID WASTE FAMUWI VEHI 4r-�� S• MAR_f Posh Qom 5��V�/ <br /> n FOOD FAOLITv 1 / l <br /> POOL/SPA B �A�J p /I OAP <br /> -(�(��y,rm(1/1. r �SrzE MmaArrox <br /> 0 DAIRY - A�Sjj M n F•�(1 05rc OAP S 1 �A'S-' v <br /> E]LAND USEAPPUGATION SITES U 5T Ran <br /> HOUMxD I,AL <br /> F1SEPnG PUMPERTRUCK I M'PP0-('A 4Ay .STvr.L_TV IV pro �p�SP � ✓r �"A/• <br /> YARD I CHEM.LTOILETS O`Tb 9 <br /> ❑WASTEWATER TREATMENT PLANT <br /> �J I I <br /> ®'CUPA <br /> HOUSING ABATEMENT i;j / 00Mfj L- 4D SgY 'M'V <br /> ❑MOTELIHOTEL <br /> PA-HA2-MAT <br /> E]CHICKEN RA1cH I DOG KENNEL <br /> ❑MEDICAL WASTE FAGILT' B �•IV( ,J r I L"' T ` q ./I(/l.(l.l ✓{�' A/ J <br /> TATTOOIBODY PIERCING / []SOLID WASTE <br /> ❑WASTE TIRE <br /> ❑COMPWNT <br /> E]OHER(PLEASE SPECIY): D UG A"�M <br /> :a f <br /> "'BOXED AREA-EHD USE ONLY'•' <br /> 23155a n 06) <br /> f ti i P Oz <br /> 1 9. 1 • 87 t7 i I 46 Af; <br /> M Raw "_pInyi('PCl by Staff-PPR <br /> eHoae.Ds WftjPtA4n E a✓rei/t `Y�I? -1-T F+ E � Z!LI&gMavr,0 A4 <br /> ag3iMrl;pe �, <br />