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� VED ti SAN JOAQUIN COUNTY tir EHD LOG NUMBER <br /> PjOV l S 2016 ENVIRONMENTAL HEALTH DEPARTMENT 815100 <br /> 1868 Easl Hazelton Avenue,Stockton,CA 95205-6232 <br /> ENVIRONMENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www,sigov.org/ehd <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: �1 4,. -f.' BUSINESSIAOENCY: ��� 0 le AC.. <br /> ADDRESS: - U _ CITYISTATEIZIP: 0 %r 1 D <br /> PHONE(1): PHONE(2): FAX OR E-MAIL:'j-.&Ir"cz PgCfZEn ' C- <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EX REQUES S F E(CASH OR CHEEK ONLY)-REQUEST PROCESSED IN 3 BUSIN A S <br /> SIGNATURE OF APPLICA DATE '6 <br /> 1. List up to ten arldressetvin the space belpy. Selectmetypok . f files from the list below by chec I the a propriate <br /> box(es). At least one file type MUST be sWected. Fax to J20 0138 or mall 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 REC DS ARE AVAILABLE FOR RENEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List ap-Description; <br /> Specific Date Range of information Requested: From to I I) <br /> ENVIRONMENTAL LI U J 1� �S, 1 A- �G <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> NDERGROQND TANK JUST) Street# Street Name City <br /> INNER <br /> CLEANUP SITE(LOP) �CLN <br /> 0/0 RICLEANUPSUE(NORi-LOP) W �Tl U C-rare, Yr�hs'► r�av�n u�f tiP <br /> 1 I11AL1R000S WASTE ,I t. ' • O /��` 1]OURV <br /> (�/tIEREO PERMITTED FACN.RY ] ��,1�R j-]";�{/, � N I ,t U�/ (•(/( I /2 <br /> G?AMECROUNO TANK I'tt tlr N S IA <br /> I; <br /> 4 (MOWTORINc/RENOv <br /> / []PWS <br /> I ADDVS MATEPMLS vr11„I,�,(1 <br /> SPKLIRELEASE RESPONSE <br /> Tl�I (' WATERDY4IlT <br /> dSOLO WASTE FACKIrY I VEHICLE . Vo ('^' <br /> FMD FA UITY y <br /> POOL/SPAA "n/� ■■A�-a. mMlnwnoN <br /> r��✓IRYUEE APPLICATION SITES Sanim I • va <br /> 34 ETIC PUMPER TRUCK I �HODMIa <br /> 6 <br /> n WAPO/CNEYxAL TOILETS <br /> ASTEWATER TREATMENT PLANT OUPA <br /> ❑HOUSING ABATEMENT T <br /> MOTELAIOTEL <br /> DHICAEN RANCH I DOG KENNEL OUPA-UST <br /> ❑MEDICAL WASTE FACILRY S <br /> E]TATTOO19ODY PIERCNo $OLIO WAsiE <br /> []WASTE TIRE <br /> 9 <br /> ❑COYPIAWT <br /> OEHERtPLEASE SPECIFY). ❑ApgINRNp <br /> 40 <br /> "I OXEO AREA-EHD USE ONLY"' <br /> If;' -' IO 7 " n 510 d- L)EVItz7 <br /> 6 ' .D <br /> 13 Records provided by Staff-PPR Complete. staff Name: <br /> END 4346 <br />