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m Jul 14. 2016 12 : 52PM No. 0694 P. 1 <br /> '� SAN JOQUIN OUNTY <br /> EHD LOG NUMBER®a¢� t Ism CEfED� i�/J�E D ENVIRONMENTALHEALCHDEPARus <br /> t� n n.. <br /> 168 East Hazelton Aenue, <br /> t& '��� I �) ��(e"3 Telephonee(209)468-3420 Faxv(209)464 Of138 Weh5205-6232 wwwsjgov.org/ehd o <br /> •EdVIRONMEITIP1 HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> La 'se o v:I� t <br /> APPLICANT: W Gvw BUSINESS/AGENCY: GYz el/(Pon n.e <br /> ADDRESS: CITYISTATE/ZIP: �1,I,l2r-a\.I C'� `'I <br /> PHONE(1): PHONE(2): FAX OR E-MAIL Ayi Pea� 1 <br /> Please allow 10 business days from date of application submittal forthe 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 REQU T- FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT __---- DATE -7—(Ci-1(Q <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 appllcant <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: MONDAY•FRIDAY 8:00 AM.5:O0PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS N <br /> FILES O <br /> E 1•=� U� ONLY <br /> X1 <br /> NDEReR0uN0 TANK(UST) street f Street Name city <br /> • CLEANUP SRE(LOP) 3430 S. E1 FSP Lopi1 t O-M —/A ❑CONSUMER <br /> OTHER CLEANUP Sim(MCN-LOP) <br /> 5 Df p `-� J}U(� M_7 `Y <br /> HA]ARDOUG WASTE f, ❑DMRY <br /> TIERED PERMITTED FACILITY ? S-1� (1 �� Pa" O� - <br /> r�f A60veGRouNP TANK ✓ <br /> �rJIL <br /> UST(MONITORINe/REMOVAL) �Q(QQ��f( �(11}� �r �PW9 <br /> HAZARDOUS MATERIALS ' .388S Si � P" <br /> SPnURELEASE RESPONSE +I <br /> yL,1 I �).{� (�� WATER QUALITY IIID, <br /> SOLID WASTE PACILRY NEHICIE R �Ib4n / 1GK� le,� yAT�p C/\ L u <br /> ❑F000 FACILIN I <br /> ❑ 14 <br /> POOL/SPA ITE MITIGATION <br /> ❑DAIRY S <br /> t�LAND LIMAPPLIcATION SITES �� I <br /> f�{.�� MON91N0 <br /> SEPTIC PUMPER TRUCK/ r V LI <br /> YARD/CHEMICAL TOILETS -, •V�C <br /> WASTEWATER TREATMENT PLANT CUPA <br /> HOUSINOASATEMENT T <br /> ❑MOTEUHOTEL <br /> ' <br /> El <br /> CHICKEN RANCH/Dov KENNEL CUPA U�I <br /> e <br /> MEDICAL WASTE FACILOY <br /> ❑TATTONSODY PIEROWG IDiSOUD WASTE <br /> IRWASTE TIRE S <br /> ACOMPLAINT <br /> Fl OTHER(PLEASE SPECIFY): ❑ADCot,.NO <br /> 10 <br /> FOXED AREA-EHD USE ONLY... <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Time=Jul, 14, '2016-12: 55PM-No. 0973 <br />