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bUtIfty SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �jQV I 0 2016 ENVIRONMENTAL HEALTH DEPARTMENTISH <br /> 1: (2 East Hazelton Avenue, Stockton, CA b: www.sjgov,org/ehd <br /> 050? a <br /> ENVIRONMENTAL HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION /- <br /> *APPLICANT: k-��O _ L.Q-z_ BUSINESS/AGENCY: h C Lla <br /> ADDRESS: c:j 7 $- L)i CITY/STATE/ZIP: j <br /> PHONE (1): — PHONE (2): q82-29 -2 <br /> >C) FAX OR E-MAIL: ZG�j) �'�j r <br /> ease allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 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 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) /� � .^ /� �/j��/� ❑CONSUNEr <br /> OTHER CLEANUP SITE(NDN-LOP) YQ Q I s r d s ,u< I <br /> HAZARDOUS WASTE DAIRY <br /> `TIERED PERMITTED FACILITY 2 �l 101� t� <br /> ®•ABOVEGROUND TANK A S &G ot/Jh D �i t- I O• 1 l- <br /> UST (MONITORING/REMOVAL) {� , / I PWS <br /> DHA RDOUS MATERIALS ; �lf'?� D U` `> e\S �p0.cl L L4 Y V C?� `'1061'1 <br /> SPILURELEASE RESPONSE <br /> Waren QUALITYSOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY <br /> POOL/SPA nfam MITIGATION <br /> S <br /> DAIRY S 1 � S ti1a>1roe. S� ck �� <br /> SLW D USE APPLICATION SITES <br /> HOUSING <br /> SEPTIC PUMPER TRUCK I 6 nn ,IL,, <br /> YARD/CHEMICALToILETs , (� �C I Q � 5'1 V 1�1 <br /> ❑WASTEWATER TREATMENT PLANT ( ^ CUPA <br /> HOUSING ABATEMENT T <br /> ❑McHzUHOTEL <br /> CHICKEN RANCH/DOG KENNEL /C -UST <br /> ❑MEDICAL WASTE FACILITY <br /> TATTOOIBOOY PIERCING SOLID WASTE <br /> ❑WASTE TIRE <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> \NM10�ph� ° �32� S �a I✓r24o�✓��. {{lam �ocK�ar( <br /> —BOXED AREA-EHD USE ONLY- <br /> 7Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />