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F - _CEI 1d' ED <br /> SAN JOA00A Environmental Health Department <br /> C O 1.l r,,]T Al 69 2048 PUBLIC RECORDS RELEASE APPLICATION <br /> F-WRONMENFAL F IT BYEMAIL <br /> PENMfT/r . ! EHD LOG NUMBER: <br /> APPLICANT: ok ,4 BUSINESS/AGENCY: CZ-:i't N 4 <br /> ADDRESS: VPQ1 yy_&1 CITY/STATE/ZIP: <br /> PHONE (1): 5,5q 905 q-%RA PHONE(2):55T 98f S]I FAX OR E-MAIL: ne�uplYtlO.�[w g,,�;�p <br /> Please allow 10 business days from date of application submittal for the records to S�availabl4VI <br /> Staff will contact yo Arran a an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE__ 6 <br /> 1. List up to ten addresses in spa ow. Address ranges WILL NOT be accepted. Select the type(s)of files rom the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 mail to the <br /> address indicated below or email to info(@sIcehd.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:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List E Map— Description: <br /> Specific Date Range of Information Requested: From to 4 `1 0 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> derground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) o CONSUMER <br /> Other Cleanup Site(Non-LOP) 1 399 <br /> Hazardous Waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> E]Aboveground Tank <br /> E]UST (Monitoring/Removal) r,\ 0 PWS <br /> Hazardous Materials I I( �'• V D <br /> Spill/Release Response <br /> Solid Waste Facility/Vehicle 4 WATER QUALITY <br /> ❑Food Facility <br /> Pool I Spa SITE MITIGATION <br /> Dairy 8 <br /> Land Use Application Sites <br /> Septic Pumper Truck/ 8 HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUPA <br /> ❑Housing Abatement 7 AST I HM/HW <br /> El Motel/Hotel <br /> Ej Chicken Ranch/Dog Kennel t7 CUPA <br /> 8 <br /> Medical Waste Facility UST <br /> F1 Tattoo/Body Piercing <br /> SOLID WASTE <br /> F1 Waste Tire 8 ❑ <br /> F]Complaint <br /> Other(Please Specify) O AccouNTINO <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> vCHt"i_ c � ii1C'G. o ► 2 v� <br /> Records provided by Staff-PPR Complete. Staff Name: EHD 48-08 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />