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r=RECEI,\V,( ED 11/17/2016 08:s7 te0so P.001/001 <br />■ DATE RECEIVED EHD LOG NUMBER <br />■ NOV 17 261V SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT `��� <br />•NVIRODJA tfUU F�.� 1: (2 East Hazelton Avenue, Stockton, CA b: wwwsjgov.org/ehd 5 <br />���/T,Eft��g Telephone: (209) 466-3420 Fax: (209) 464-0138 Web: wwW.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />4 <br />APPLICANT:(Gd..oCa 11 jrjl�;elnLne.. BUSINESS/AGENCY:61.Te•s". L..•('�` (A'oTgo <br />ADDRESS: L27c> Syr;.,gb..k e0 .IL(OI CITY/STATEIZIP: L1,IA.Mu� c�••t, GA 9vf -/ <br />PHONE (1): 4Z r'• 'I tf1'-vQsuA 2 <br />PHONE : "kZr-Sn7- TS71 <br />() - FAX OR E-MAIL: rbl.; <.IEHe.Q <r•P�SIP-+Pr.•N+- m. <br />Please allow 1D business days from date of application submittal forthe records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDI A $1 FE R CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ` � DATE /fel -7/1 6 <br />1. List un 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 12091464-0138 cr 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />Electronic Information: Le List L] Map — Description: <br />Specific Date Range of Information Requested: From Trio to P.Ps« fi <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESSFILES <br />EHD USE ONLY <br />(� UNDERGROUND TANK (UST) <br />x CLEANUP SITE (LOP) <br />&OTHER CLEANUP SITE (NDN -LOP) <br />treetR <br />Street Name <br />City <br />-not <br />0 <br />W. Pe u�P` v� �� <br />__T;1 y <br />El CoNsUMER <br />P. �•i _ <br />M—RDOUS WASTE- <br />n TIERED PERMITTED FACILITY <br />LRABOVEGROUND TANK <br />2 <br />(g�( <br />�A/ <br />1tA' - Pt• - e•O <br />13� <br />R <br />I�3s <br />W • PPS Cwd'e•o <br />� <br />(y�L �I � <br />C) PWS <br />,1 ���I _ / <br />aUST (MONITORING / REMOVAL) <br />Q'HAZAPDOUS MATERIALS <br />E@SPILLIRELEPSE RESPONSE <br />k5 <br />pp <br />L' - R_5e_ e a Ave <br />}� <br />T—aY L% <br />WATER GUAITY <br />� <br />n SOLID WASTE FACILITY / VENICE OO <br />❑ FD FACILITY <br />Pool /SPA (/f �r/ <br />E Jy^^ll <br />DANDY USE APPLICATION . <br />LAND <br />SEPTIC PUMPER TRUC / 11 <br />YARD l CHEMICAL TOILETS <br />�KoIS <br />l✓• j�x�u� ,c <br />FO <br />✓c <br />SITE MmCUnoN <br />{1 <br />, �12/� C TS C10 <br />' <br />A OE \ 1L / <br />t(I IZV tX3-o6o 7-6 <br />❑ HOUSING <br />❑ WASTEWATER TREATMENT PIANT <br />HOUSING ABATEMENT <br />E] MOTEUHOTEt <br />T <br />)��� �(./ <br />�A-1., <br />` <br />\J <br />COPA <br />CHICKEN RANCH / DOG KENNEL <br />Rl CUPA - UST <br />❑ MEDICAL WASTE FACILITY <br />[TATTOO(BODY PIERCING <br />n WASTE TIRE <br />CDMPIAINT <br />9 <br />❑ SOLID WASTE <br />OTHER(PLEASE SPECIFY): <br />10 <br />t] ACCgVMIrvp <br />-BOXED AREA - EHD USE ONLY - <br />Received Time Nov, 17. 2016 8 49AM No.0367 <br />1 L/�5 <br />7 <br />