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RECEIVED <br /> SAN -,IUA UIN <br /> Environmental Health Department <br /> C"(J N T Y PUBLIC RECORDS RELEASE APPLICATION <br /> At <br /> i_, ;r�,NVIR0NV1ENT <br /> PEF;M /SE p BYEMAIL <br /> • EHD LOG NUMBER: <br /> ry <br /> APPLICANT: � ! %! � /� BUSINESSIAGENCY: S f c 'i <br /> ADDRESS: F . r< tp;{wry <br /> f lj6 CITYISTATE/ZIP: -'L �,rh t L4 <br /> PHONE(1): � PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact Y u to ar an s an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT] ' e- ' DATE -/42_ / , 4 <br /> 1. List up to ten addresses r the space below. Address ranges WILL NOT be accepted. Select the types files from the F <br /> list below by checkingthe 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(cr)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) ;L,�> <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> rHgd <br /> ES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ank(UST) Street# Street Name City <br /> CONSUMER <br /> LOP)Site(Nan-LOP) 61 jFf jIlste ( V. p'DaIRr <br /> El Tiered Permitted Facility 2 f [ � <br /> Aboveground Tank /C4 ��' , l' �'I <br /> LIST (Monitoring I Removal) PV s I, <br /> "ti lLc�S -Z <br /> Hazardous Materials ) l <br /> Q -7� F <br /> Spill/Release Response M �( 2(7 A Quaun <br /> Solid Waste Facility/vehicle 4 2 <br /> v <br /> Food Facility <br /> Pool!Spa I.114,(.,.�.. SITE MITIGATION <br /> Dairy <br /> vJ _S <br /> Land Use Application Sites <br /> I/'D ��v��(/Ir ©'`HOUSING _ <br /> Septic Pumper Truck/ a l v <br /> Yard!Chemical Toilets <br /> k,A y 12'CUPA <br /> Wastewater Treatmont Plant t <br /> Housing Abatement 7 ASTI HM I HW <br /> MotellHotel ? ' J -'t > _ n 1r,'t1PA f[ <br /> Chicken Ranch I Dog Kennel ' II <br /> Ov'^ <br /> UST l <br /> Medical Waste Facility '�V <br /> Fj TattoolBody Piercing d <br /> sono WASTE <br /> Waste Tire 9 <br /> Complaint <br /> AccouNnNG <br /> Ej Other(Please SpeclfY): ❑ : <br /> 10 <br /> 'BOXED AREA-EHD USE ONLY*** <br /> M <br /> u <br /> A- <br /> 0 <br /> -❑ Records provided by Staff-PPR Complete. start Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />