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K1=VCIWAQUII ECEIVERironmental Health Department <br /> JAN, 1`l� COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> ss grows here <br /> CJAN 17- 2018 1 <br /> ENVfR9NMENTAL fi€`AL`�A i- <br /> PERMIT/SER ES RQIIIYlEAITALHEALM EHD LOG NUMBER: .- <br /> •APPLICANT: 7 t fk'LR't/ 1 BUSINESS/AGENCY: <br /> (4�f �n�6 n fe�lh Q / clfC • S�-rc <br /> ADDRESS: n t ,n CITY/STATE/ZIP: q_ g5=6 <br /> PHONE (1): 0� • 2�'EjQ _ PHONE (2): FAX OR E-MAIL: <br /> T Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact/yo to grange an appointment date and time to review the requested ec rds. <br /> SIGNATURE OF APPLICANT K,L+�MJ L r DATE I If�15'- <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select thee types) of files from 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(d,)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) z3 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ®,Underground Tank(UST) Street# Street Name city <br /> ONS MER <br /> Cleanup Site(LOP) •^/ <br /> Other Cleanup Site(Non-LOP) (/'��� ���(�' 0 S(,t,,• t �0 <br /> ®Hazardous Waste aav <br /> ip Tiered Permitted Facility 2 / 0 ) <br /> ®Abovegmund Tank r E ` o n I <br /> TPWS <br /> UST (Monitoring/Removal) I <br /> 3 <br /> ®Hazardous Materials <br /> Spill/Release Response <br /> AtER tlwinv <br /> ®Solid Waste Facility/Vehicle 4 <br /> ®Food Facility <br /> Sn MmcnnoN <br /> Pool/Spa <br /> Dairy S <br /> Land Use Application Sites <br /> ousiNc <br /> ®Septic Pumper Truck/ a <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant VCUPA <br /> Housing Abatement r ASTI HM/HW <br /> Motel/Hotel <br /> ®Chicken Ranch/Dog Kennel CUPA <br /> a UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing SOLID WASTE <br /> Waste Tire g <br /> Complaint <br /> Y❑"Other(Please Specify): 0 Accourmac <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> In <br /> Records provided by Staff-PPR Complete. staff Name: EHD 48-05 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />