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RECEIVED EHD LOG NUMBER DATE RECEIVED V SAN JOAQUIN COUNTY OPS MAY ny 6 20% ENVIRONMENTAL HEALTH DEPA 1668 East Hazelton Avenue,, 952 Stockton, CA 95205-6232 _r.`VIRONMEWAt-p'EAT Telephone:(209)458-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd PERMITfSERVICES PUBLIC RECORDS RELEASE APPLICATION aL"' APPLICANT: 1,111I'TA - ea'TI r BUSINESSIAGENCY: I Avg)-N T9 c WELL- Ajo ADDRESS: /7 "��f)-e 1'a k k A Zje , 5(,)ITF' 7 LL)) CITYISTATEIZIP: SLFn�J '�FJ fEr/A PHONE(1): ( -�f S ��Lf-f PHONE(2j: s� -OO��J FAX OR E-MAIL: 1.yT 1-,�,.,, {^/; Please allow 10 business days from date of application submittal for the records to be available. U Staff will contact you to arrange an appointment date and time to review the requested records. E.CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT MA A Ks r p�v DATE D5-12--617 O GG 1. List unto ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address Indicated above. Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file.not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$130 deposit prior to review. WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) Electronic Information: ❑ List❑ Map-Description: Specific Date Range of Information Requested: From to 1 ENVIRONMENTAL - 14fi !) fifflor HEALTHDEPARTMENT FILE ADDRESS FILES EHD USE ONLY I (UNDERGROUND TANK(UST) Street# Street Name City {J�� L Y''CLEANUP SITE(LOP) A / LTW Vg { �, CONSUMER ' ,23x3 M/tPI fbS•Ft 2oaD STvck I pN Y�I OTHER CLEANUP SITE NON-LOP � Cj a -�tIZI+HAZARDOUS WASTE /� ,1 L - 0 'L� DAIRY TIERED PERMITTED FACILITY 2 _/(3( MAP(IT}Y'A. L�/0 A_4�.� f ro � 7v rj ry / [ ABOVEGROUND TANK `l I77 MAP rill I-+1I�AM1�-- PWS 'I�LR('7�Y,.UST (MONRORING/REMOVAL) 'NJ HAZARDOUS MATERAL$ ( 1 A A A-O (PyCA /Yil/S?\ S��I • /11 {1 /� Q SPILL/RELEASE RESPONSE Sf,v WATER QUALM Y❑'SOLID WASTE FACILITY I VEHI 4 It/1 f I Kj OS�j ��- '"I"I � r {T WI E]FWD FACILITY ❑POOL I SPA 'BITE MITIGAnON ❑DAIRY 6 AS1 MH-IP0SA� eDAO s',vct- /D ❑LAND USE APPLICATION SITES ST IU4t•I H... Lam} ❑SEPTIC PUMPER TRUCK/ B P G ^/T"A •_(( A 4hp I'mOS ^L Tv(V 0 c 1 ! ✓11 YARD/CHEMICAL TOILETS 1� /� ld� V ❑WASTEWATER TREATMENT PLANT 1/ / ®CUPA ❑HOUSING ABATEMENT T I-OO A�I1S & /D S70a7V0 )oat MyJ� l ❑CHICKEN AM rVl (I� 1✓L-h- L \ PA HAZ-MAT CHICKEN FLINCH/DOG KENNEL �� •/ OLJ / ❑ ° P��O( S F W `I q a MEDICAL WASTE FACIM' ❑TATTOO/aODY PIERCING E]SOLIDWASTE ❑WASTE TIRE 9 �� J ��ryy ❑COMPLllNT - �jTrwaoy�g�C�RDU4 ❑OTHER(PLEASE SPECIFY)_ LC YI L1( - W13/lS'° (U(j/9w�F r� [yC./✓•- fni sa4 I ""BOXED AREA-EHD USE ONLY—* 5. e hol, a 3 S� n ,(16) tF i 0 Oz 1 �. I l$-7 6 Of 1,10 b r 46 aP; Staff-RPR EHD 48.06 winrp - &4-e,'I/I `It L4-11 F � a 4 q�-,0yea 2N3FM ',¢d5�