Laserfiche WebLink
RECEIVED <br /> SAN JOAQUIN ITE4Y 0 7 zui, Environmental Health Department <br /> COUNTY d PUBLIC RECORDS RELEASE APPLICATION <br /> i_ IL VV\ <br /> PE MW <br /> • h EHD LOG NUMBER: � � <br /> APPLICANT: ✓d BUSINESS/AGENCY: r- w A16c",P ' <br /> ADDRESS: CITY/STATE/ZIP:, <br /> PHONE(1). - PHONE(2): C2 -7-t ^" FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact yo arran a an a pointment date and time to review the requestedecords. <br /> SIGNATURE OF APPLICANT__ �i� _ DATE 5'��>"�8 <br /> 1. List up to ten addresses int a space belo ddress ranges WILL NOT be accepted.Select the ty ep (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(a-)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 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. l� <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 ��- r1T 0. �-17 <br /> - <br /> HEALTH DEPARTMENT <br /> FL FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> 'f-Underground Tank(UST) Street# Street Name City AD <br /> joeanup Site(LOP) �n ) �}y�r, 4W . µM r , CONSUMER <br /> er Cleanup Site(Non-LOP) ' �7'3 �/�i'S'�" �(l� ' t+w, rtA�l, W/sP <br /> jazardous <br /> Waste Tu- AIRY <br /> ed Permitted Facility s a l �'1�'�'�y� n J G� 5 <br /> oveground Tank ^+` P <br /> JST(Monitoring 1 Removal) 3 1 � te <br /> ��•'t'' < f t n^. rr}vv, rA�`� PWS <br /> ardous MaterialsCs >�G(G <br /> pill I Release Response ' <br /> Solid Waste Facility 1 Vehicle , WATER QUALM <br /> J�q� t� G <br /> n Food Facility l / t !� N M ,SITE MITIGATION <br /> F-1 Pool/Spa 5 <br /> DairyW (fid Co 5 <br /> O Land Use Application Sites �4,H�� N vi, 1.1 AA HOUSING <br /> Septic Pumper Truck 6 J <br /> �Yard I Chemical Toilets / <br /> Wastewater Treatment Plant 7 /0j 11-1 M H M OV t}VN, CUPA <br /> ❑Housing Abatement 0 tp,5 °'ST t HM!HW <br /> Motel/Hotel r • CUPA <br /> F-I Chicken Ranch I Dog Kennel s UST <br /> F-I Medical Waste Facility <br /> M Tattoo/Body Piercing a ❑SOLID WASTE <br /> ❑Waste Tire <br /> F1 Complaint ❑ACCOUNTING <br /> Other(Please Specify): 10 <br /> '*'BOXED AREA-EHD USE ONLY— <br /> &t a ?-tc L ti , Gb C"A �1 <br /> • CG► 00 3 t �- ql r Si06 <br /> awli' b t yD r u���^7 4�3i1 0 , <br /> taf PPR rr QlTlpletA,Staff Name: I-1 Q� e 1� JV / t/VC DWq <br /> w-tq-tV LDDdN25jt FErPV t o IhA h Ie liar (V&V n t P 043671S-t� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 46-3�20�209 464-0138 1 www.sjcehd.com <br /> Priv.(/ 001V ( 9 <br />