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"Cv <br /> D '^ �"� � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN 10 1017 P10 0 04VIRONMENTAL HEALTH DEPARTMENO //�/ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 wu 5911 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: ww.sjgov.org/ehd V <br /> R4' � TM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q Q(1MkillAir BUSINESSIAGENCY:_ <br /> ADDRESS: ?A LSI-6 10$ CITY/STATE/ZIP: firQSh 0� CA r13 <br /> PHONE(1): 155q�28(0- 5 ID(p PHONE(2)z �7ta_ Il X111 FAX OR E-MAIL: r�RhlPlr4�f�G�IY1tGOY1.YtPrl <br /> Please allow 10 business days from date of application submittal for the records to be availab e. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. 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 (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 RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS 3�� �' <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) WV - ' CONSUMEN <br /> ,OTHER CLEANUP Sim(NON-LOP) T 5 Unpin We/ �an��, IVO - 'Up �vf ❑ <br /> 9 HAZARDOUS WASTE . A <br /> TIERED PERMITTED FACILITY 2 (�55 N unto In RY �an CGv ❑DAIRY,w <br /> l�ABOVEGROUND TANK <br /> g[UST (MONITORING/REMOVAL) ��/ ����/.� ❑PWS <br /> HAZARDOUS MATERIM-S (\�+/'� 8 <br /> ®SPILURELEASE REGPONSE,/ l <br /> ®SOLID WASTE FACILITY/VEHICLES 4 /n 7+F Lincoln IkV� Man1-�c� WATER Q.__ <br /> F1 FOOD FACILITY <br /> ❑POOL/SPA /^ tf SITE MITIGATION <br /> DAIRY 5 (Db I W Manua, <br /> i4 LAND USE APPUCARON � <br /> SD7nC PUMPER TRUCK/ d '^1'^ ,/� 1.. ` n Q i HouslxG <br /> L i� B (9 W Malr l .� 1 Nlan{'L-(.� U """ ///CZ) <br /> YARD/CHEMICAL To r�nn l ,/Q T <br /> R WASTEWATER TREATMQ P�T"\ (f� /� .. A w' '• /CUPA <br /> O HOTEUHO EL ENT IN <br /> X <br /> 7 MID Ill l�'n A '�/`0,()W,t, ' <br /> MOTEL/HOTEL �/ "t '••V^ Y <br /> CHICKEN RANCH/DOG CUPA-UST <br /> l�MEDICAL WASTE FACILITY 8 <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE9 SOLID WASTE <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY"" <br /> -Z ' <br /> i <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />