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RECEIVED <br /> DATE RECEIVE N JOAQUIN COUNTY EHD LOO NUMBER <br /> rtb 13 2017 ENVIRONMENTAL HEALTH DEPARTMENT ''''''���/// �02 <br /> R0NMV4TAL W_AVH 1868 East Hazelton Avenue,Stockton, CA 95205-6232 �[ /✓") <br /> • PERA111T1^ts5'<\�4'L 0 ,-. Telephone:(209)468-34 0 Fax:(209)464-0138 Web:www.sjgov.org/ehd rv] <br /> PUBLIC REC RDS RELEASE APPLICATION <br /> APPLICANT: r- i for �r BUSINESSIAGENCY: eTnet E.,daee;wr 45 <br /> ADDRESS: u +aYY.EYA o $1 CITY/STATE2IP: <br /> PHONE(1): q% !'105 -12.-j5 PHON (2): q/6-938--736.5 FAX OR E-MAIL: GN�a+ <br /> Please allow 10 business days from ate of application submittal for the records to be available. <br /> Staff will contact you to arrange an Ippointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQU STA$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2-10.17 <br /> 1. List up to ten addresses in SI, space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one filet a MUST be selected Fax to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications receive d after 3:00 pm will be processed the next business day. <br /> 2. For assistance in Identifying the nature and contint 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 re uire a$139 deposit prior to review. <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVAILAB E FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: Fr)m to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES s <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SUE(LOP) 1�l y ❑CONeUNEO <br /> • [TOTHER CLEANUP SITE(NON-LOP) <br /> E <br /> gHPSMDOUS WASTE ,llF 0 DIJflY <br /> ®TIERED PERMITTED FACILITY R <br /> [ffAScWNROUND TANK I <br /> MUST (MONITORING I REMOVAL) oQ r r L L ❑PWS <br /> CgHA2M IOUS MATERIALS 0 j'g� C C6 1 of w K� �kO Gr tOti <br /> SPILUREIEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 WATER OuuRv <br /> FOOD FACILITY <br /> POOL/SPACC 11�� hl .ty SrtE MITIGATION <br /> DAIRY 5 GKA <br /> ❑LAND USE APPLICATION SIZES 1,l O~ <br /> SEPTIC PUMPER TRUCK/ fi JOS ` Uf Me YN LrNkt,tY 11--n S+o�k�e-` �HOUSIxO <br /> L JJ <br /> YARD CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT + <br /> ❑HOUSING ABATEMENT T 117,1 <br /> 6tN,"41Afa., k- <br /> ., k- <br /> ,1J CUPA <br /> MOTEL/HCEL �? v <br /> 11 <br /> CHICKEN RANCH/DOG KENNEL fi ��� C- 1101, <br /> ,+MN 1 w�l y.,, CUPA 11TMEDICAL WASTE FACILITY1+ h I` <br /> ❑TATTOO/BODY PIERCING <br /> � 1 SauD WAnE <br /> WASTE TIRE t <br /> 1016❑❑COMPLAINT LID <br /> OTHER(PLEASE SPECIFY): <br /> '('BOXED AREA-EHD USE ONLY"' <br /> 6 Records provided by Staff-PPR Complete. staff NBRlIN _ <br /> EHD M-06 -- <br />