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g-IVE® EHD LOG NUMBER <br /> UUUU�RRTTrr��EE"'' CC SAN.IOAQUIN COUNTY <br /> rdov 18 201U ENVIRONMENTAL HEALTH DEPARTMENT 815100 <br /> 1868 Easl Hazelton Avenue,Stockton,CA 95205-6232 <br /> ENVIRONMENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> • PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 C ' 2 BUSINESS/AGENCY: If-twW Al CilC r - <br /> --7 <br /> ADDRESS: 0 - - CITYISTATEIZIP: p V .!v to <br /> PHONE(1): PHONE(2): FAX OR E-MAIL, -G�IIM-A.fCZ 10C!- n T G <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 appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EX TE REQUES -S FOE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINFF. S DAYS <br /> SIGNATURE OF APPLICA DATE <br /> 1. List uo to ten addresae In the space be elect he lyp ( f files from the list below by checking theappropriate <br /> box(es). At least one file type MUST be selected. Fax o 20 0138 or mall 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 tiles 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 REG9RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List ap-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> NOERGROUND TANK(LIST) Street# Street Name City <br /> CLEANUP SITE(LOP) L/A]�/IL 1�LI ��LI I� {. p I 1t�n1 fJ 1 .y,}I�'LM �CcH�ouEA <br /> � �OL/yER CLEANUP SrtE(Na1-lOP) N'/�J MrLiWt ��(11vV \ • L L"" ' � /f Vtl`j�, \ _Co <br /> 11—RODUS WA5TE I tAW. (I ❑CI <br /> �WKIERED PERMITTED FACRRY 1 Cy .+!j '�1D m� I'7 J N � I 'I� kyKl <br /> B/1BOVEGROUND TANK 7V( {� <br /> 1 t IMONITORINGIREMOVAL) PWS <br /> VDeus MATERIALS <br /> SPILURELEASE RESPONSE 7+L`^ , rt vlv LSA, WATERDu4II1 <br /> dSOLM,WASTE FACILITYI VEHICLET/)��O <br /> �FooG FACILITY <br /> ��//�t <br /> POOL I SPA ny/� L ( 7 A VI�A./lA i NiwnoN <br /> j� A�IRYY a /iI k.jmp�L /L�^ I V111V'VtL <br /> �LAyu USE APPLICATION SITES yV7L'( ILN71V1'`/�Il rlur I ,rq`i1^�~/'y' <br /> �-pl p Hwvru <br /> /EPTIC PUMPER TRUCK/ - <br /> PARD I CHEMKIAL TOILETS <br /> In(WASTEWATER TREATMENT PLANT t CURIA <br /> (]HOUSING ABATEMENT <br /> ❑MOTEUHDTEL <br /> ❑CHICKEN RANCH I DOG KENNEL r In CUPA-UST <br /> ❑MEDICAL WASTE FACILITY e <br /> TATTO01BODY PIERCING Soup W�nE <br /> WASTE TIRE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECRY) ❑AavUNPNG <br /> 70 <br /> "'BOXED MEA-EHD USE ONLY"' <br /> • Il l <br /> (3 Records provided by Staff-PPR Complete. staff NSISQ: L <br /> EHD4MG <br />