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N01- eE <br /> DATE W14 2016 Np <br /> A(QQUINCOUNTY ���� EHD LOG NUMBER <br /> f=NVIRONMENTALHEAL - —.4VIRONMMAAENTAL HEALTH D'EPARTMEA � <br /> l=EtiITf sER4�dCE5 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.oE/IL E CC* <br /> PUBLIC RECORDS RELEASE APPLICATION 7 . <br /> 1 PLICANT: G(O..tF`el 4"A BUSINESS/AGENCY: FWAIG Af i�f r; , G <br /> ADDRESS: R110 li�71� _,+_ - 1-I CITY/STATE/ZIP: (it'U•f'�I ')'f D� (,A �79 i4 <br /> PHOI4E(1): (qf(1)4'i7b—(1( j PHONE(2): FAX OR E-[',RAIL: No 126—�33� <br /> Please allow 10 business days from date of application submittal for the records to be airailable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT �� ��Tc4j� DATE ���� 1(,::;,1. List up 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 cond'tion 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$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW/J: MONDAY-FRIDAY 8:00 AIR-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From t0 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT RLE ADDRESS <br /> FILES - EHD USE ONLY <br /> ID/UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) I <br /> CONSUMER <br /> THER CLEANUP SITE(NON-LOP) [DWWI)WWI) l.,v> <br /> HAZARDOUS WASTE <br /> CLARY <br /> TIERED PERMITTED FACILITY 2 /•�J tp Jn <br /> dA80VEGROUND N /r4'TANK " o (lm h <br /> E�rUST (MONITORING/P.EMOV.AL) � I � \/•� ❑PWS II <br /> HAZARDOUS MATERIALS ��J�j� to t!1) Lob <br /> 12/SPILLIRELEASE RESPONSE V 1 y I WATER QUALITY r <br /> SOLID WASTE FACILITY/VEHICLE �v 1� _• LAI � <br /> � L�I I <br /> FOOD FACILITY '� •([/yl,�/ U`Ti�l •lr� <br /> E]POOL/SPA SITE MITIGATION <br /> DAIRY 6 I f Y <br /> t f V <br /> F-1 LAND USE APPLICATION SITES e HDUSIw^ <br /> SEPTIC PUMPER TRUCK/ S `J1-• <br /> YARD/CHEMICAL TOILETS -J %v t, l / I" ` V n <br /> 2/WASTEWATER TREATMENT PLANT CUPA <br /> HOUSING ABATEMENT 7t^D I r-1Do �71 �g (VI) LZ e <br /> MOTEUHOTEL � ! I IVI�VI ` '`Un(�/f�, <br /> CHICKEN RANCH/DOG KENNEL �• _,.�i UPA-HAZ-MAT <br /> F-1 MEDICAL WASTE FACILITY 6 =I"�1� �• Of/n y�/� ;4�! �/'� <br /> F�TATTOO/BODY PIERCING E2 SOLID WASTE <br /> YwASTE TIRE 9 y�,I y �r_ <br /> COMPLAINT I0t1 VI t/• Z`f,/VF _1 �fUl '`' 7 <br /> F OTHER(PLEASE SPECIFY): 1! - ACCOUNTING <br /> MAI �6et 0 10 yr <br /> "'BOXED AREA•EHD USE ONLY— <br /> U00 <br /> NLY"U 0 Alfie 1. rb CaO 6-VX -fo cel cis Y'��2ss' ':�%P x ue.,;f <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />