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DATE RECEIVED <br /> RECEI�e SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �7 ® 1 �IVIRONMENTAL HEALTH DEPARTMEN SIC <br /> r(&AI 1 East Hazelton Avenue, Stockton, CA 95205-641,•�`MAY 16 2017crl $Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd 7 <br /> Aft,',— 3,,• PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: <br /> ADDRESS: S , XF A. CITY/STATE/ZIP: <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 contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE UEST-$139�FE�E,jfCASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �h. f- I t�t m DATE,5 /6- <br /> 1. List up to ten addresses in the space below. Select the type(s) of file4jforn 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ] List)] Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> C NUP SITE(LOP) <br /> OTHER CLEANUP SITE(NON-LOP) �V CJ{+r� �["�f4/ 6 "([,(` �l J 1 �^+O �"v" ❑CorvsuMER <br /> HPIAROOUs WASTE /T9u�-.��I /��� �[,... <br /> TIERED PERMITTED FACILITY 2 Ate/7^.`�Y`��'s"`O "-� -/ / ❑DAIRY <br /> ABOVEGROUND TANK //t/ -d &2Ay <br /> �UST (MONITORING/REMOVAL) QPWS <br /> S <br /> HAZARDOUS MATERIALS <br /> SPILURELEASE RESPONSE <br /> ATER QHPlI}V <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY <br /> F1 PWT./SPA SITE MRIGATION <br /> DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 6 [1 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENCUPAT 7 - <br /> I]MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY e <br /> n TATTOO/BODY PIERCING <br /> I]WASTE TIRE B ❑SOLID WASTE <br /> ❑COMPLAINT <br /> n OTHER(PLEASE SPECIFY): <br /> 10 ❑ACCOUNTING <br /> "'BOXED AREA_-EHD USE ONLY" <br /> 5 i6 1 — -Lo/n.eJ, ou c+nL� i Vw�re {it <br /> i —I a C-oa N —IS <br /> ❑ Records provided by Staff-PPR Complete. staff NaID : <br /> EHD 46-06 <br />