Laserfiche WebLink
DAT 'R, / EIVE® EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> DEC � 2016 ENVIRONMENTAL HEALTH DEPARTMENT /1� ^ �� <br /> l• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 (Ul L <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIR4M11SER ACSS H PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/CFRtn,(`GS <br /> •APPLICANT: RLL, /�, , BUSINESS/AGENCY: <br /> ADDRESS: Ioj0jj To„ir e 0/' CITY/STATE/ZIP: <br /> PHONE(1): toy -c10 - I 11 PHONE(2): 2 oq- Y JY II I t FAX OR E-MAIL: <br /> Please 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(CgSH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l �� DATE 12 12�4 jj <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 M160 to (Y csq fi <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> T{UNDERGROUND TANK(UST) Street# Street Name City <br /> T CLEANUP SITE(LOP) QQ�(A 1yI /\�'-//� �/ _ CONSUMER <br /> 00 OTHER CLEANUPSITE(NON-LOP) 1 1©OOV kC r-�� \ 99 EJ//L/� �r� Il5 <br /> p <br /> �L�TT HAZARDOUS WASTE 1p <br /> ❑DNRY <br /> {�TIERED PERMITTED FAULTY 2 to v�(7 ®U Ar n) ' I w v Q Q <br /> ABOVEGROUND TANK ( a 6 I l_Il <br /> UST (MONITORING/REMOVAL) PWS <br /> HAZARDOUS MATERIALS G <br /> SPILURELEASE RESPONSE P���.e� L <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 WATER ODUIry <br /> 54 FOOD FAaLm <br /> ❑POOL/SPA SITE MITIGATION <br /> DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> [j HOUSING <br /> SEPTIC PUMPER TRUCK/ <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT T <br /> )]MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING 11 SOLID WASTE <br /> WASTE TIRE g <br /> COMPLAINT <br /> )]OTHER(PLEASE SPECIFY): ❑AGGouNTING <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY— <br /> 7110 Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />