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SAN JOAQUff ECEIVE <br /> • vironmental Health Department <br /> —COUNTY— JAN 10 ZDVil (1"1 PUBLIC RECORDS RELEASE APPLICATION <br /> GrCoin•5c gro6 ,s5 here. Y\\ <br /> EWRONMENTALFEWN <br /> EHD LOG NUMBER: 77 4\1 <br /> APPLICANT:/ _Sf I T7-E(Z. BUSINESS/AGENCY_57e-i�k27 -,L,1C NOVL" <br /> ADDRESS: M/0 E 't'GAr"-FL N fit✓ CITY/STATE/ZIP-SryIy r C,A 17,4:20s- <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contaco arrang a oin nt date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE I p t <br /> 1. List Up.to ten addresseslin'the spa tk,bslow. ddr s ranges WILL NOT be accepted. Select the t pe(s)of files from the 3 <br /> list below by checking the appropn''aate box(es). AILWast one file type MUST be selected. Fax to(209)464-0138 mail to the E <br /> address indicated below,or email to infoCdslcehd.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 /> 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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) ' 7 I' <br /> ` ` <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS �,( <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD U SE U N LY <br /> 'underground Tank(UST) Street# Street Name City 1 <br /> Cleanup Site(LOP) ,,,.Q�7'�_ p ^�j� J�,� „�i NM�111A((�J Coweu ,. <br /> • Other Cleanup Site(Non-LOP) r gDls �(I(.(.f Jl/', 6rov� ,� Iri()m1011 ` u��P� <br /> Hazardous Waste 5 -PR t, S� f <br /> Tiered Permitted Facility 2 /� -f1" Lt':� �1t(—J '1 ,/ n,nv <br /> Aboveground Tank 93,51 }NA.�nw- 6ybvt 12a� I/t0 N0Ci) fl U0 U�cO�s <br /> UST (Manitodng/Removal) /� /� ,1 _ 0 PWS <br /> Hazardous Materials s tet/I b'� l�/v; '/'^ r .} �Ve {�„I UmJ„^ 9 VO'�l'/'/I No (.D(�f' <br /> ,Spill/Release Response I_I r '1 Uf Y'w� K.fll 111 !l <br /> Solid Waste Facility/Vehicle d 11n nrsa Owu.nv <br /> ❑Food Facility 435b WO/I 0 61/11ve N 0�`�/F)O V <br /> �[--,,]//Pool/Spa ,^I��1,I1 �/�����1/�11 )/' I ^ �,,./ �s,j�Mmannon j <br /> Dalry ° Dq i' o r'w�lv1 nV ��I nl� 1rvt.L(T� N`�tt/ 1 /NDIQ hl/ Ili <br /> Land Use Application Sites _ I 1 1 1 1'r L I I r ` ri <br /> Ersaptic Pumper Truck/ ousirve <br /> Yard/Chemical Toilets 1) 'Ndn at Yhbvt Pd bYvl.,m <br /> � <br /> Wastewater Treatment Plant ("]� 1,, //�y�, t�,.I �M.{�^ f,, (,A�1r/%—) ^1O Lo I <br /> CUPA <br /> l� VIIUve 1`-VI �l lul lir \ "'D Iltr / ASTIHM/HW I <br /> Housing Abatement T n �,- J, <br /> Motel/Hotel (�(,��VLI f{ <br /> Chicken Ranch/Dog Kennel <br /> PA <br /> ❑Ma"an'Waste Facility r <br /> UST <br /> Tattoo/Body Piercing AL.i V Souo W <br /> Waste The 9 N D ,1(J7 1 AID lN(S k <br /> Complaint <br /> 1�2 N- 610 oYYI DYI'1 fM <br /> cD(�1❑Other(Please Speafy): � Accoum'vsc I[ <br /> '° l oo N u.5sprn bm- I <br /> *'"BOXED AREA-EHD USE ONLY-- F <br /> 1100 'E rt-"A NO LDA" /tom°a•a ;.1 m:MOIL of Ual ank ii Rt 6Y2 'k-. cbw <br /> 11- 'I r <br /> 0 Records provided by Staff-PPR Complete.Starr Nam.: lzxD leas <br /> i <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> P <br /> ( <br />