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DAT G;LIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> OCT 13 2016 ENVIRONMENTAL HEALTH DEPARTMENT ���I� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> •APPLICANT: f C L BUSINESS/AGENCY: }� ALr6Q <br /> ADDRESS: ,jty-sIa sa CITY/STATE/ZIP: �CbGK`Cr7t.( c(Sab� <br /> PHONE(1): 1)__C7 Cj &[)g— Dr�L(-d_, PHONE (2): Aoq Q'j - OF70D FAX OR E-MAIL: So_L(�r(C i�ctt�rnnv,a� <br /> Please allow 10 business days from date of application submittal for the records to be available. f <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEp{v�E`REQUEST-$139 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE DAYS <br /> SIGNATURE OF APPLICANT �p.4 (f S DATE l6 t ((o _ <br /> 1. List up to ten addresses in the spake below. Select the types) 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 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: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) tt -- n_ ❑CONSUMER <br /> to OTHER CLEANUP SITE(NON-LOP) r (�'�" .-}-� L.IJ�+ �1(b 1`_t S-0) <br /> d HA2ARDOUs WABTE l!J <br /> DAIRY <br /> dTIERED PERMITTED FACILITY 2 I/,�/� o /C 7/� <br /> F✓ABOVEGROUNDTANK 1 VI1Ca <br /> ,v <br /> UST MONITORING/REMOVAL) '+n'71-` ❑PWs <br /> [g HAZARDOUSMATERIALS 0 <br /> R SPILURELEASE RESPONSE I V rye,V <br /> dSOUDWASTEFAcIUTY/VEHICLE 4 WATER QUALM <br /> WOOD FACILITY <br /> ❑POOL/SPA Ies,TEMITIGATiON (o( <br /> ❑DAIRY 8 <br /> ❑LAND USE APPLICATION BITES <br /> ❑SEPTIC PUMPER TRUCK/ ❑8 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PI-ANT CUPA <br /> HOUSING ABATEMENT 7 <br /> ❑MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING SOLID WASTE <br /> ❑WASTE TIRE S <br /> [2rCOMPWNT <br /> n OTHER(PLEASE SPECIFY): ❑AcOOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />