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RECEIVED <br /> SANIJOAQUIN l;j> Y 7 ,j, Environmental Health Department <br /> COUNTY #-Ec PUBIC RECORDS RELEASE APPLICATION <br /> EW <br /> • IL h EHD LOG NUMBER: <br /> APPLICANT: !�� BUSINESS/AGENCY: o io <br /> ADDRESS: e4 2 CITY/STATE/ZIP: (/ <br /> PHONE(1): - ,� PHONE(2): s _ y� ? FAX OR E-MAIL: a , <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arran a an appointment date and time to review the requestedecords. <br /> SIGNATURE OF APPLICANT_ �i. _ DATE 57/?I1 S <br /> 1. List up to ten addresses inta space belo ddress 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@—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 END 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. 1� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW:MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) l <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS ( �u <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> TUnderground Tank(UST) Street# Street Name City AD <br /> anup Site(LOP) , CONSUMER <br /> � <br /> er Cleanup Site(Non-LOP) 3 W�'S� tkw li.vt, co/s{� <br /> giazardous <br /> Waste / ND DAIRY <br /> ed Permitted Facility s C CI <br /> oveground Tank +� '�' ` <br /> JIse n <br /> ST(Monitoring I Removal) 3 G l t M �W, PWS <br /> ardous Materials a3(� 1/'��'S jtiQ <br /> pill I Release Response j ddb WATER quA�m <br /> ❑Solid Waste Facility I Vehicle 4 1 �041ti �I' S�✓/,Food Facilityk' No Co 160 <br /> F�Pool 1 Spa 5 1 N/�/� SITE MITIGATION <br /> Dairy u/(rs� t �)�U' ✓� f�0 CO 5 <br /> Land Use Application Sites JA W, 4 A LJ HousING <br /> Septic Pumper Truck( 6 <br /> Yard 1 Chemical Toilets r J�`'` �' `"G' �U 5 <br /> � u CUPA <br /> Wastewater Treatment Planta; / ti M M g, ttl, <br /> F-1GAJ <br /> Housing Abatement (� `� S t' � 114 , �� ��r (415�ST I HM 1 HW <br /> ❑Motel/Hotel / ' CUPA <br /> C]Chicken Ranch 1 Dog Kennel 6 UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing s ❑SOLID WASTE <br /> E]Waste Tire <br /> Complaint ❑ACCOUNTING <br /> Other(Please Specify): 16 i <br /> "*"BOXED AREA-EHD USE <br /> ONLY-4 ' -= -i U kit <br /> • : GO OO 3 t J- awP r 5106 <br /> ATPs al f �95 L0D01 `ID r510b) L <br /> 60 dol D3' 0 <br /> to#f-PPR-G.OmpJete,stall r+ame: (p (Z Q � e f -307 1149 r D <br /> w 1cr-I t n ttvj ,2 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 46-3,VO I F 209 464-0138 ( www.sjcehd.com <br /> PrJv.C/ 00a, c,�'> <br />