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DATR / EIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DEC Z 7 2OtB 'ONVIRONMENTAL HEALTH DEPARTMENT 652313 <br /> 1: (2 East Hazelton Avenue, Stockton, CA b:ww 6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIR4hMENTAL REALTH <br /> 13FRUTISER111rGe PUBLIC RECORDS RELEASE APPLICATION <br /> 'APPLICANT: RnLBUSINESS/AGENCY: <br /> ADDRESS: AG q IP op CITY/STATE/ZIP: .lt <br /> PHONE(1): S it)a PHONE (2): 7 oq- LlI FAX OR E-MAIL; ' <br /> Jx- e �q� <br /> P ease 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 JL(2J l� <br /> 1. List un 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 ai(da t0 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS a 3 EHD USE ONLY <br /> �/ FILES <br /> 17y UNDERGROUND TANK(UST) Street# Street Name ity -P <br /> - 7�' CLEANUP SITE(LOP) Qpm 1GA11y) A' l)O CDIS'11R <br /> OTHER CLEANUP SITE(NON-LOP) T ©00 V �C �" „r/ \ 'V O I I'w <br /> ff) bI DOUS WASTE I <br /> toTIERED PERMITTED FACILITY 2 V O��I(� ^ 'r. H '` I V /l �„�y �.l"/ 1 ! r �� ) ❑DY I�� <br /> [Z ABOVEGROUND TANK r l6 /v VV I Ali O <br /> DUST (MONTORING/REMOVAL) El PWG <br /> .9HAZARDOUSMATERIALS 3 <br /> SPILLIRELEASE RESPONSE <br /> ❑SOLID WASTE FACILITY)VEHICLE 4 WFTER DUALITY <br /> FOOD FACILITY <br /> ❑POOL/SPA SITE MITIGATION <br /> ❑DAIRY 6 <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ 6 D HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTEUHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY S <br /> ❑TATTOO/BOOY PIERCING <br /> ❑WASTE TIRE S ❑SOLID WASTE <br /> ❑COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): <br /> 1 D ❑ACOOUNNNG <br /> ""BOXED AREA-EHD USE ONLY- <br /> — <br /> C QG7 C <br /> VI <br /> 7 ` y �f Icy <br /> El Records provided by Staff-PPR Complete. SIBrr Name: <br /> EHD 48-06 <br />