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• <br />• <br />aLoa.z5 RECEIVED <br />SAN J OA Q U I N JAN 2 4 201�Environmentai Health Department <br />COUNTY— — cgiei 3Opn PUBLIC RECORDS RELEASE APPLICATION <br />it CWR01111111166AL �M EHD LOG NUMBER: <br />67079 <br />APPLICANT: eJ`L0,te_ <br />ADDRESS: 5 W, <br />PHONE (1): 310 . R l I- 237 PHONE (2): FAX OR E-MAIL: �4hi ®au l 0't Rn.vye <br />Please allow 10 business days from date of application submittal for the records to be Ziabl . �^ <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT aNJL. ge,�yrv..t, DATE/ 201 & <br />1. List up to ten addresses in thspace below. Address ranges WILL NOT be accepted. 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 infot@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 />P. <br />4 -NI, <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. /Z <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 />Specific Date Range of Information Requested: From 14tf 6— to C.t.VtA•ti-/— <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />FILES <br />(Specific addresses <br />only, address ranges will not be accepted) <br />EHD USE ONLY <br />UIMerground Tank (DST) <br />exD teas <br />Streets <br />Street Name city <br />Cleanup 5110 (LOP) <br />t <br />7,V457 <br />.0 1-1m,l . <br />W &ST Ct "_r <br />❑cauwen <br />E] Other Cleanup Site (Non -LOP) <br />5-1 <br />[l'Haxallous Waste <br />� Tierad Permitted Facility <br />Z <br />r'M's <br />VST- I I#So [' D41r f' }'-Rr�' (} HNj <br />V <br />D Dem <br />Aboveground Tank <br />a �! <br />d \ Lh 3C� <br />D Pwis <br />UST (Monitoring / Removal) <br />g-H.,cme us Nationals <br />a <br />C <br />it ty <br />t. cif <br />EgApill l Release Response <br />. <br />SST' (�(�(fiAi( <br />wssw nry <br />�Ow <br />El Solid Waste Facidty, I Vehicle <br />C] Food Fatality <br />InI�_.M1,.CCO <br />ACCO <br />DS 4020 .1 W <br />Cl Sea Mmosaoa <br />I1 Pool I Sp <br />❑ Dalry <br />5 <br />O <br />J <br />AAA IYl-SSA, Au <br />Land Use Application Sites <br />6 <br />W I7 <br />s <br />Do L0—e tl'eyr% IAV—. <br />[3 HoueN6 <br />[] Septic Pumper Truck l <br />Yard I Chemical Toilets <br />- CA av% t f- <br />rj Wastewater Treatment Plant <br />AUPA <br />DiTco 'Alt- <br />❑ Housing Abatement <br />❑MolelMotel <br />T <br />DfTCO 7RC44R't^-• <br />ASTIHMIHW <br />. <br />t) OlQ <br />, R <br />13 CUPA <br />Chicken Reach I Dog Kennel <br />Medical Wast. Facility <br />I <br />n w U� <br />9 <br />UST <br />Tallodeody Piercing <br />rj Waste Tire <br />y <br />L <br />aa� <br />{{yy n❑Soto <br />frlT I}is'OCr blit <br />WAart <br />Y <br />D Complaint <br />) <br />S CTJ�. <br />Other (Please Specify): <br />,a <br />CySc <br />ISD• 2-71100 fN J' suP.ctret, <br />1] AC.T.. <br />"'BOXED AREA- EHD USE ONLY• <br />808 E. H [ton Avon e 1 S ckton, Califomi 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />is 7D co <br />UJ &Am c{' 1 9 5 f-1 � %ter I S I fro dogto C Ci, <br />❑ Records <br />provided by Staff -PPR Complete. She Nam.: <br />exD teas <br />808 E. H [ton Avon e 1 S ckton, Califomi 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />is 7D co <br />UJ &Am c{' 1 9 5 f-1 � %ter I S I fro dogto C Ci, <br />