Laserfiche WebLink
RECEIVE® <br /> SAN- JOAQUIN " 10 2017 Environmental Health Department <br /> —COUNTY-EW� �f � PUBLIC RECORDS RELEASE APPLICATION <br /> • Greatness grows lie re.PEPWIT/Sf 9 (& 7 <br /> EHD LOG NUMBER: (& X4 <br /> APPLICANT: 4 BUSINESSIAGENCY: /4?G <br /> ADDRESS: 11171,9" 'OALO Q C- So/T u-o 1 CITYISTATEIZIP:W10*Is(-Sra_ 95351 <br /> PHONE(1): .,207 579 2,A.A PHONE(2): FAX OR E-MAIL: �2 09' <br /> Please allow 10 business days from dat of a lication submittal for the records to be available. <br /> Staff will contact y-oy torr yn e an a nt date and time to review the requested rec ds. <br /> SIGNATURE OF APPLICANT_. DATE /p /0 / <br /> 1. List up to ten addresses in the space below✓.A mss r�WILL NOT be accepted. Select the ty (s)9f 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 infoOsicehd.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) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY <br /> FILES addresses only,address ran es will not be acce ted <br /> -ffUnderground Tank(UST) A <br /> Street# Street Name City <br /> CI nup Site(LOP) / ❑c cWER <br /> Other Cleanup Site(Non-L 1 93/ 'wAl )II + C- s�oc(eA <br /> a..rdons West. 0 DAIRY <br /> le.d Permitted Facility 2 <br /> Aboveground Tank <br /> hZ <br /> [MIST (Monitoring/Removal) I7 PWS <br /> F�j<zardcus Materials a <br /> Q pill/Release Response t �J /� <br /> ❑Solid Waste Facility/Vehicle 4 1 44 � -6 ArER quem <br /> E]Food Facility ` J t <br /> Pool/Spa I I m / 51rE MmoAnory <br /> El Dairy 6 t (� <br /> Land Use Application Sites <br /> Septic Pumper Truck/ ❑6 Hell.l.e <br /> I <br /> Yard I Chemical Toilets <br /> ❑Wastewater Treatment Plant , UPA <br /> E]Housing Abatement r n /j.-) _ AST/HM/HW <br /> 1­1Motel/Hotel v `_JIY n <br /> ❑Chicken Ranch I Dog Kennel CUPA <br /> 8 UST <br /> Medical Waste Facility <br /> ❑Tattoo/Body Piercing p Sotlo W.�tta <br /> ❑Waste Tire e <br /> ❑Complaint <br /> ❑Other(Please Specify): ❑Accotnrim <br /> 10 <br /> � ( ""BOXED AREA-EHD USE ONLY' <br /> -AD-t'7- Er`P. ' Q "C41 ' (YCu(A A MA aL tt l- . l <br /> • <br /> ❑ Records provided by Staff-PPR Complete.Staff Name: aeo eeas <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />