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RECEIVED <br /> SAN J O A Q U I R1AY 25 1018 Environmental Health Department <br /> C O U P_.!-T 'ErtylRONMEWlu- PUBLIC RECORDS RELEASE APPLICATION <br /> ��°.�� 7 <br /> IR IT BY EMAIL• _Zq414HD LOG NUMBER: <br /> APPLICANT: K4.Q A *k BUSINESSIAGENCY: -rt yYA-L0✓l <br /> ADDRESS: 102,1 E IIA�11 ✓� `K CITYJSTATEIZIP: 4+'0(A1hL CAr 9SZo <br /> PHONE(1): L�lta)2yto -Sa`1� PHONE(2): FAX OR E-MAIL: Hg4A-Ab <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Go r� <br /> Staff will contact you to arran an a ointment�WILL <br /> N�ZTbe <br /> d tito review the requestedDrecords. <br /> � - IS <br /> SIGNATURE OF APPLICANT <br /> 1. List up to ten addresses in the space below. Address rangea�ccepted�Select the types)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 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 /> as released <br /> 4. Any file not returned in the same condition 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. <br /> EVIEW: MONDAY-FRIDAY 8:00 AM•S:OOPM(EXCLUDING HOLIDAYS) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR R <br /> Electronic Information: ❑ List❑ Map-Description: <br /> to <br /> Specific Date Range of Information Requested: From <br /> FE <br /> VIRONMENTAL 2CD l� <br /> FILE ADDRESS <br /> TH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD U S E O Y <br /> FILES Cit <br /> Underground Tank(UST) Street# Street Name Y <br /> CONSUMER <br /> up Site(LOP) 1 2 I E. F+a�,eli�rl Rarevl�.Cleanup Site(Non-LOP) [3 DAIRY <br /> dous Waste Permitted Facility 2 1h?2 Scott's X01-�J�U„�ground Tank 1 V JJ ❑PWS <br /> UST (Monitoring I Removal) \ <br /> Hazardous Materials <br /> �3S E. sus �VA� ��A m <br /> Spill I Release Response r' WATER DUALITY <br /> r tti trt� ,L v •�• <br /> Solid Waste Facility 1 Vehicle 4 �y8 s t o A S+y-LQ-+ u� <br /> Food Facility O \ SITE MmGATION <br /> ❑Pool/SpaEl r /- d( 1,- t� <br /> 6 �oO J. /T�/�►tea Y r�C.C.T CYl t1�� • • <br /> Dairy <br /> HOUSING <br /> Fj <br /> Land Use Application Sites lir��'�i�Ty"l'1't <br /> Septic Pumper Truck/ 6 tD�J <br /> Yard/Chemical Toilets J J f 1 1 (97U-PA- <br /> Wastewater <br /> 9UPAWastewater Treatment Plant AST I HM I HW <br /> ❑'l Housing Abatement <br /> Motel/Hotel 9CUPA <br /> Chicken Ranch/Dog Kennel UST <br /> 8 <br /> Medical Waste Facility <br /> OLID WASTE <br /> TattooiBody Piercing <br /> Waste Tire 9 <br /> complaint []AOCOUNTING <br /> Other(Please Specify): <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> � EHD 48.06 <br /> ❑ Records provided by Staff-PPR Complete. stair me: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 v+nvw.sjcehd.cotr <br />