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OSE To: 12094640136 From: 19164800603 Date: 05/31/16 Time: 3:5 M Page: 01/01 <br /> EHD LOG NUMBER <br /> rDATE ^� R"" SAN JOAQUIN COUNTY <br /> ■% vcf it iL� ��1VE3� ENVIRONMENTAL HEALTH DEPARTMENT <br /> ppie „F� C'1868 East Hazelton Avenue, Stockton. CA 95205-6232 <br /> MAY-44- l� Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgcv.org/ehd <br /> L..14MMQt�F� IM EXX1 1-16f`L5_! PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAMMF�gT r�� ke Hf1 EUSINESS/AGENCY: FnPrrnn q. rvir.-C <br /> ADDRESS: 14,151 River Park Drive SOitf, 100 CITY/STATE/ZIP: S2rramPntn. CA 95816 <br /> RHONE/1 : 916-,A00-0236 PHO E(2): nv n E-fr AIL . I L,. <br /> � ) !�_�_,. Fes,. P, �. Lllvri0flPciiicfCOi).COill <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact youtoarrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE RFS'@VEST-Siff FELE(CASH OR CHECK ON '-LY)-REOUESPROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /� ✓1v�1 2-i DATE NAa4/ 21 201 R <br /> 1. List up to ten addresses in the s ace belo . Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)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 (i0) <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 $130 deposit prior to review. <br /> WELL AND SEPTIC PERII01T RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:001CM (EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List ❑ Map —Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL 1 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> Fl LEs EHD USE ONLY <br /> fUN7ERGROUNO TANK(UST) Street# Street Name City <br /> Y CL EPNUP SITE(LOP) ❑CcNsu'' <br /> IF, CLEANUP SITE INON•LOP , i!'l�� 1�/act F ramnnt C tl-aPt CtocktOr <br /> HA:ARDOUS WASTE 0 <br /> IERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> UST (MONITORING/REMOVAL) ❑PW5 <br /> 3 <br /> 9 A:ARDOUS MATERIALS <br /> .fPILL/REL EASE RESPONSE ®WATre QUALITY <br /> OLID WASTE FACILITY/VEHICLE 4 rVrl/� <br /> FOOD FACILITY <br /> ❑POOL/SPA H SITE MITIJATION <br /> DAIRY 5 <br /> 1 LAND USE APPLICATION SITES <br /> o EPTIC PUMPER TRUCK/ 6 HOUSING <br /> YARD/CHEMICAL TOILETS / <br /> WASTEWATER TREATMENT PLANT Ef CUPA <br /> SING <br /> E]HOUABATEMENT 7 L! <br /> I1 MOTEUHOTEL <br /> CHICKEN RANCH/DOC KENNEL Q CUPA-HAZ-MAT <br /> B <br /> MEDICAL WASTE FACILITY / <br /> TATTOWBODY PIERCING SOLID WASTE <br /> WASTE TIRE 9 <br /> ,h, COMPLAINT <br /> OTHER(PLEASE SPECIFY): 0 ACCGUv- _ <br /> �D <br /> "'BOXED AREA-EHD USE ONLY­ <br /> r_1 <br /> 31�Y201 (�'MOD <br /> 5�7PIV�No.'OS28staffName: <br /> EHD 46-06 <br />