Laserfiche WebLink
EricExton Fax:(888)501-3250 To +12094640138 - <br /> ! yt _ Fax +12094640138 Page 1 D(1 08/01/2016 12:46 PM <br /> !!! <br /> SAN'.,JOAQUIN;COUNTY • EHD LOG NUN46ER <br /> AUG 0 r 20bE ENVIRONMENTAL HEALTH QEPARTMENT <br /> . 1868 East Hazeitori gvenue Stockton CA 95205 6232' <br /> Telephone: (209)468-3426 Fix (209)A64 0138 Web wvnvs)gpv.org/ehd- <br /> �€12Cf�SVEi} ALCiEAEEf9 PUSL€CRECORDSRELEkSEAF+PLfClfiftON <br /> APPLICANT_:_'_PC C, ) BUSINESSlAGENCYj <br /> ADDRESS: 2$2 Mitt,-igekCk�: <br /> —= — 160 CITY/STATEIZIP' LQS <br /> PHONE(1): (-tt�()66'i KoS� �x, I!L-, PHONE(2): - FAK ORE-MAfL. .._ ew <br /> Please allow 10 tipsiness days froth data.of application strbinittal for thefeccrds to be available.� C <br /> Staff will contact you to arrange an apppirrtment tlaf4 and time to reweuv She requested records. <br /> a f m ' Er �AS.H <br /> OZ'11E€3"ONL4, REDUESa PF;OCESSEIO)1rif GIME 3: A�'S <br /> SIGNATURE OF APPLICANT _ DATE O <br /> 9. List up to ten addresses m the space below Select the type(,)of files trom the list befow by checking the appropriate <br /> box(es). At least one file fype[MUST.be selected, -Fax to(209).464-0,136 or mall to'tlie address ihdidated above Address <br /> ranges will not be accepted:IApplieationsreceived after 3.00 pm,wtll be processed the.next bUsiiTess day.' <br /> 2. For assistance rn idenfdyingthe nature and contentof EHD records,pleasecontactEHD at the number noted above. <br /> s'. The EHD will notify the applicant If any EHD files exist. An appointme <br /> daysafter receipt of application. nt for review will be confirmed approximately fen(10) <br /> : The Ntes will be held for at maximum-of five.business days forreview. 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 theapplicantFuture file reviews by the same applicant mayrequi re a$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MON DAY <br /> -FRIDAY 8:00 AM•S:DOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information; 7011❑Map-7 Description: - <br /> Specific Date Range of lnfortnation Requested; From to <br /> fVtFX[i;F�rt3Ed3A& <br /> tf ALT I P T tf 7 FILE ADDRESS <br /> '� 'EHD USE ONLY <br /> UNDERGROUND TANK fu$TJ' Street 4'. Street Name city: <br /> CLEANUP,SDE(LOP) p. _ <br /> OTHER CLEANUP SnE(nbN-LOP) ❑coNsuien <br /> HAZARDous WASTE i,V 1C.Jt 1W'�I <br /> 1❑y�TIERED PERMITTED FACILITY E:DAIRYLl <br /> EABOVEGROUND TANK <br /> R[I <br /> UST (MONROR9JG/REMOVAL) 1Vy t ! •'1• ❑PW$ <br /> to HAZARDOUS MATERIALS I <br /> 4W SPIWrigEASE REBPONBF - <br /> SOURw4SMFACILRY'IVV41CLE _ WATJt DLµITY <br /> FOOD FACILITY - <br /> POOL SPA <br /> DAIRY ,i 5' _, 1 �' /� �I o /❑$f1ELWl4RTON <br /> ❑LAND UeEAF-PLICATIONSITES• <br /> SEPTIC PLMPeit TRUCK/ <br /> 6. ., .. ❑HlD9 <br /> YARD/GIEMKU TG:ETS . <br /> WASTEWATER TReADNeNr PLANT . <br /> (]HOusINC AacTENENT 'T - . . CUPA` <br /> n MOTEUHGTEL - .. . .. <br /> F1 CHICKEN RAIJGH/DOG.KENNU <br /> E]MEDICAL WASTE FACILITY E cu-A-NJ11.MhT <br /> TATOOIBODY PIERCING <br /> WASTE-11 URE e - (]Sou.tv.T <br /> �COMFIR r .. <br /> OTHER(REASE SPECIFY): <br /> —, BOXED AREA__EHD ONLY"' <br /> ❑ Records provided by Staff-PPR Cgmplete .sraff Name: <br /> 6Ho 4a-os - - <br /> Received Time Aug. 1. 2016 10:45AM No. 1039 <br />