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RECEIV5b <br /> A �Q N Environmental Health Department <br /> COUNTY— NOV � E Zu�� //�P�U�LIC RECORDS RELEASE A�LICAT)�1 <br /> 11111fdONhtEhfSA' FI LYS t l b EHD LOG NUMBER:jyVJ)7 <br /> f7�7 {� <br /> APPLICANT: r• �nC�t BUSINESSIAGENCY: Ajnt( �nvt nett�in J <br /> ADDRESS: St`gncl C pn[cr C 4H51 CITYISTATEOP: t <br /> /A� FAX ORE-MAIL: Malc hoA 4�l O 6f-yVIQ i� COA'l <br /> PHONE(1): 'I Z J -Z 8 2` O ZS PHONE(2): <br /> Please allow 10 Business days from date of application submittal for the records to ted do available. <br /> staff will contact you to arrange pointment date and time to review the rD TEst111 1 <br /> SIGNATURE OF APPLICANT s of fi as from the <br /> 1. L'st uo to ten addresses in the space bel Address renges WILL NOT be accepted. Select the type(s) <br /> list below by checking the appropriate b x(es). At least one file type MUST be selected. Fax to l be processed <br /> mail a the <br /> address indicated below or email to info -mhd.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 <br /> to (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App <br /> should be scheduled accordingly. �I/ice 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. l f_ <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 / OU <br /> to Nse-1� <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> FILES Ci <br /> Undupraund Tenx(UST) Street# Skeet Name city 13 <br /> coNei <br /> cleanup SMe(LOP) 1 ' ) L <br /> Other cleenw site(Non{OP I u,`Z� w • ��`�L/flt� Ave– rmoyi+t Ccj <br /> ❑ONay <br /> Hazardous We he <br /> Tlerad Panni6ed Facility g <br /> • Abwei dTen, �PWs <br /> r7i UST (MWtmirg I R 01) g <br /> Hazardous Ma .I. ^.M— <br /> Sptl/Release Rasponee <br /> Sdid Wrote Fecidy/Vduda 4 <br /> ❑Food Facaty SrtsNmwnoN <br /> ❑Pod 1 spe <br /> S <br /> ❑DahY p Houseto <br /> ❑Land Use Application Sires <br /> ❑sepdc Pumper Truck I g <br /> Yetd/Chemical Toilets _.. - ........_.- CLIFA F <br /> �j wee,mater TmatmeM Plant AST I HM I m <br /> ❑Housing Abatement T <br /> ❑MdelMdel uPA <br /> ❑cltic,an Rant I Dog xannel UST <br /> e <br /> ❑Mitral Ww.Faclky �Wy <br /> ❑Tmow9ody PieNng ., <br /> inWaste The B <br /> ❑C Plea m ❑ALCWNIMG <br /> ❑other(Please speriy): <br /> ig <br /> "B 'KED AREA-EHD USE ONLY"" <br /> 'h <br /> In <br /> I <br /> END 4646 <br /> D Records rovided by Staff PPR Com fete. staff Name: <br /> • 1868 E. Hazelton Avenue I Stockton, Califomia 952051 T 209 468- 4201 F 209 64-0138 sjcehd.com <br />