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DA . Urs --- <br />IwF.t��VE SAN JOAQUIN COUNTY <br />RONMENTAL HEALTH DEPARTMENT • <br />1868 <br />sat <br />Hazelton Avenue, Stockton, CA 95205-6232 <br />Al 2 0 20J6 ID- Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ADDRESS: <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: <br />CITY/STAT E/ZIP: L• <br />EHD LOG NUMBER <br />I= <br />PHONE (1): ;�I -yjZQ - 2>Z7� PHONE (2): 17M FAX OR E-MAIL: C 101) S"'7D - 3JG <br />Please allow, 10 business days from date of application submittal for the records to be avallable. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST- $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />1. List up 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 (209) 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 flies 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 - <br />Range of Information Requested: From <br />0 <br />ENVIRONMENTAL <br />FALTH DEPARTMENT <br />FILES <br />FILE ADDRESS <br />e a <br />EHD USE ONLY <br />DERGROUND TANK (UST) <br />Street# <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />( OTHER CLEANUP SITE (NON- ' <br />L�iHAZARDous WASTE <br />dTIERED PERMITTED FACILITY <br />91�%-OVEGROUND TANK <br />BUST (MONITORING / REMOVAL) <br />dHAZARDOUS MATERIALS <br />EgISPILURELEASE RESPONSE <br />SOLID WASTE FACILITY/ VEHICLE <br />❑ FOOD FACILITY <br />❑ POOL/ SPA <br />❑ DAIRY <br />❑ LAND USE APPLICATION SITES <br />❑ SEPTIC PUMPER TRUCK/ <br />MCARO / CHEMICAL TOILETS <br />-TEWATER TREATMENT PLANT <br />❑ HOUSING ABATEMENT <br />❑ MOTEUHOTGL <br />❑ CHICKEN RANCH / DOG KENNEL <br />❑ MEDICAL WASTE FACILITY <br />❑ TATTOO/BODY PIERCING <br />Fg/WASTE TIRE <br />❑ COMPLAINT <br />❑ OTHER(PLEASE SPECIFY): <br />CONSUMER <br />r /2 Ste, h t C42T, Aq Ayl <br />I r X!!h"ui Ala r.Q j � <br />❑ DAIRY <br />2 <br />G I I ---------------------[-]- PWs <br />' D]SITE MITIGATION fJiW��� <br />5 <br />6 I I ❑ HO.Aws <br />8 I I I II 9 CUPA - HAZ-MAT <br />WASTE <br />'D I I E] ACCOUNTING <br />•.. BOXED AREA - EHD USE ONLY - <br />10 1`0 15 AlI <br />!Recordsprovided <br />❑ by Staff -PPR Complete. staff Name: <br />EHD 48.06 <br />