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RECEIVED I* <br /> DATE RECEIVED SAN JOAQUIN CO EHD LOG NUMBER <br /> JAN I f2017 ENVIRONMENTAL HEALTH EJ <br /> TMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd 5 4 <br /> PEI's ITASEWI MS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MCt/� ��ac�l�ii , BUSINESSIAGENCY: <br /> ADDRESS: Q(n S;'cn�/ (} , LOftLc� f! CITY/STATEOP: <br /> PHONE(1): �'� 7 f 7-��-7 F�2 PHONE(2): FAX OR E-MAIL: - 1i"Z�l i✓.i- itif r��, <<n <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 BOXTO EX2EDIT. REQU T:=$139 FEE,(COR CHECK'ONLY)-REQUEST PROCESSED N 3 IBUSkES5 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the sp ce bel elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST b lected. 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: 0 List[] Map-Description: <br /> Specific Date Range of Information Requested: From 611 to <br /> ENVIRONMENTAL <br /> HEALTKMPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street 9 Street Name City <br /> CLEANUP SITE(LOP) ^ - / ❑CONSUMER <br /> y I,OTHER CLEANUP SITE(NON-LO )j', L ��� f r� � V <br /> r-' ���fff i ( �7UL ��..,{ .-X.�1(�I'�Z �?'f.?G r�`.'i •J <br /> HAZARDOUS WASTE <br /> /J,r'�/J,T ❑DAIRY 2 <br /> I/I TIERED PERMITTED FACILITY 2 {r t +( ,�` <br /> ABOVEGROUND TANK e•5f � �u 1 �' I T�;.r_Z 1'�( <br /> T PWS <br /> .{UST(MONITORING/REMOVAL) <br /> 1/1 HAZARDOUS MATERIALS 3 <br /> SPILLIRELEASE RESPONSE <br /> IA WATER QUALITY <br /> SOLID WASTE FACILIIT(Y'/VEHICLE 4 <br /> FOOD FACILITY /v <br /> POOL I SPA SITE MITIGATION <br /> DAIRY $ <br /> n LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK I HOUSING <br /> 6 <br /> YARD I CHEMICAL TOILETS <br /> E]WASTEWATER TREATMENT PLANT PfCUPA <br /> ❑HOUSING ABATEMENT 7 <br /> MOTEVHOTEL <br /> F]CHICKEN RANCH f DDG KENNEL 16 CUPA-LIST <br /> n MEDICAL WASTE FACILITY 6 <br /> TATTOOIBODY PIERCING <br /> SOLID WASTE <br /> I]WASTE TIRE <br /> 9 <br /> F1 COMPLAINT �. '� 1 <br /> n OTHER(PLEASE SPECIFY): Q ACCOUNTING <br /> 10 <br /> -BOXED AREA-EHD USE ONLY- <br /> fill 1 —1 <br /> ❑Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />