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ECEIV4 rw0d tab <br /> SAN�JOAQUIN �� vironmental Health Department <br /> —COUNTY— CCT 6 U 2017 PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness grows here. ENVIRON:1'E'V'Al STH <br /> PERMIT/SE EHD LOG NUMBER: <br /> APPLICANT: Lie BUSINESS/AGENCY: <br /> ADDRESS: A3-3�, Ciao CITY/STATE/ZIP: &ACWL�— CA <br /> PHONE (1): a,oc, 5$60a''-k\ PHONE (2): FAX OR E-MAIL: <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 tment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ��— DATE \O`bll� <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138, mail to the <br /> address indicated below, or email to info(a)_sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) I l <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to Cu V\-'e_ <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 p ) EHD USE ONLY <br /> FILES (Specific addresses only,address ran es will not be acce ted <br /> Ig-Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ❑CONSUMER <br /> .'Other Cleanup Site(Non-LOP) 8)b S tAA O N 41 o <br /> Hazardous Waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> 1ST (Monitoring/Removal) ElPWS <br /> 7 t <br /> E.,/Hazardous Materials ` <br /> pa apill/Release Response ' 1 WATER qunutt <br /> Solid Waste Facility/Vehicle 41 y}moo, ` b <br /> Food Facility Pool[spa ( 61 /� 1 ��ff++��� iTE MincAnoN <br /> t'Nv`c� rl UJ e <br /> 5 <br /> Dairy <br /> ❑ Land Use Application Sites HOUSING <br /> ta�gepdc Pumper Truck/ 6 <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> ❑ Motel/Hotel CUPA <br /> ❑Chicken Ranch I Dog Kennel <br /> 6 LIST <br /> ❑Medical Waste Facility <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire e <br /> Complaint <br /> ❑ Other(Please Specify): ❑AecoennNG <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY'** <br /> LEIRecords provided <br /> e. Start Name: eHo4a-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />