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DR EC. I'VE <br /> SAN.JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 16 216 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 YowJY' <br /> ENVIRCMtEN-AL HEALTH Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> PERMIUSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: JVAVI BUSINESS/AGENCY: CA" Oct o✓L ccx-i{ - R ullcWt, <br /> ADDRESS: IVO L L j+CA Z `Lt }O✓) kkj- CITY/STATE/ZIP-S)"OG�I'U✓l - C't ri',Z Q y <br /> PHONE(1): Z( _ L46g - 1�0 Iv 6 PHONE(2): FAX OR E-MAIL: J(aC(C�Vpr�lpnp 5)o,A/ OR <br /> Please allow 10 business days from date of application submittal for the records to bd'available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDI I IFCT- EE(C9 R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List u to ten addresses pace a ow. Select the type(s)of file (from the list below by checking the appropriate <br /> box(es). At least one fi a MUST be selected. Fax to f209)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 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 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 I to l ) <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) �j 130 Ofral jWtvw 120 TYD"JD a57-P(_�0 <br /> I <br /> VVOTHER CLEANUP SrtE(NON-LOP) <br /> OHAWtDOUS WASTE 3t�o l (,`pf ra l I dol lvw <br /> TIERED PERMITTED FACILITY y R t't�� p , tjp 4lJ ❑D^�" <br /> ABOVEGROUND TANK <br /> �UST (MONITORING/REMOVAL �o�O� Cnrrat I�o1 lOw Itlq /L� i PWS <br /> �A HAZARDOUS MATERIALS 3 <br /> l!y OIPMA <br /> SPILURELEASE RESPONSE ,,^^(( �M/� /�,., ( r] _ 1 /� "IA1 <br /> E]SOLID WASTE FACRTTY/VEHICLE ` �L10W �O�'Yr^I I IIOw 1(,.(jT TtI^��� u�� ��O1 ///-]]1 WATER OUN.IIY !/ <br /> ❑FOOD FACILITY D '/ 0 <br /> ❑POOL/SPA N yL r <br /> ❑ $ RE MITIGATION <br /> DAIRY <br /> LAND USE APPLICATION SITEs <br /> ❑SEPTIC PUMPER TRUCK/ L]HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT T PA <br /> ❑MOTEUHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-LIST[:]MEDICAL WASTE FACILITY 6 <br /> ❑TATTOO/BODY PIERCING <br /> ❑WASTE TIRE ❑SOLD WASTE <br /> 8 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): <br /> 'D �A6WMIN3 <br /> "'BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />