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19 2017 09:37AM Enviro Assess 8776235493 page 1 <br /> RECEIVED <br /> i I <br /> SA NAMU I N o_ ) � ��� Environmental Health i epartment <br /> .___COUNTY_._..._. �C <br /> ,. / PUBLIC RECORDS RELEA' E APPLICATION <br /> • �`!_�_,,_,.`" f`,rec,tnese <�,^ueys here. F O (1W c1 <br /> RMMIT/S YA CE.3LTH !; : <br /> PEIAMIT�ERvJ9�ES IZ•)� <br /> APPLICANT: I EHD LOG NUMB <br /> BUSINESS/AGENCY: <br /> ADDRESS: J S <br /> PHONE(1):(� �V PHONE(2): CITY/9TATE2IP: <br /> FAX OR EMAIL: <br /> Please allow 10 business days from date of application submittal for the records to be aJl Mable. <br /> Staff will contact to arrange an appoin nt date and time to review the requested r co e, ce <br /> SIGNATURE OFAPPLICANT�.�.� ',+Ty <br /> S. <br /> 1. List uo to tan addresses in the pace elow. AA dress ranges yyl� OI4�j T be a cepted. DATE <br /> the Z- r� IO J <br /> hat below by checking the appropriate box(es), qt least one file typ S) of flies from the <br /> address indicated below o email to info s'cehd.eom. A IicattyionsM ceived after,3e00 d. Fm will be 138 mall to the <br /> business day. PP P p, ceased the next <br /> 2. For assistance in Identifying the nature and content of EHD records, please contact END at the numb Ir noted below. <br /> 3. The END will notify the applicant if any EHD files exist. An appointment for review will be confirmed proximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for revie <br /> should be scheduled accordingly. Appointments <br /> 4. Future file reviews by the same Any file not returned in the same condition as released will be reorganized by END staff at the ex <br /> pensi I of the applicant <br /> ire a$152 <br /> osit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS applicant <br /> AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM•5.00pM(EXG. UDING HOLIDAYS) <br /> IN�6 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> 1. <br /> Specc Date Range of Information Requested; From <br /> ENVIRONMENTAL to <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (SPecIfic addresses only,address ranges will not be accepted) HD I Z ZO' <br /> ndes9mund Tank(UST) street# E ONLY <br /> Fleanup Sita(LOP) ,( ` street Name Cay <br /> �Ln/Other Cleanup She(Non-LO ' 7Y�I yv�$� `I. i_ _) U(�- P� .2Z C sum A <br /> Io hazardous Waste ILIO g-1 D <br /> ❑Tiered Permitted Facility 2 I <br /> [r].'AboVagmrmtl Tank ❑ AV <br /> [)'GST Noniordng/Removal) <br /> 1919szardous Materials S C]PWS <br /> Spill/Release Response <br /> VEolid Waste Facility/Vehicle <br /> Food Facility <br /> WATak dual,, <br /> ❑Pod/Spa <br /> ❑Dairy 5 <br /> SITE Mnn"Tfaa <br /> []Lary Use Applicatlm She. <br /> Sepik Pumper Truck/ { <br /> Yard/Chemical Tollefa a ❑Housiw <br /> ET�Vastawater Treatment Plant l <br /> []Housing Abatement <br /> TCOPA <br /> C M nnel .'i ASTIHM/HW <br /> ChickeICken Ranch/ <br /> Dog Kennel <br /> Medlcal Waste FaclI ty a CUPA <br /> [�TahoWBcdy Piercing UST <br /> Waste Tire <br /> eouo wmb <br /> [] ComplalM � <br /> Q Other(Please Specify); <br /> 10 <br /> vlIJ0823 I ❑ r aA000� s <br /> BOXED AREA_END SEONLY— t/IW h e" <br /> I�,IK-I — Cti11 � <br /> P, C F 2 ft'V'k oc r 6 <br /> t. <br /> 10111 111: 11! <br /> I .Z <br /> 5 <br /> oo ll Yi yryftf 11 Q ,eI- <br /> 45 <br /> 1868 E. elton Avenue) Stockton, Calif omia 9520$ ?Og 48& 02 F 209 IGg4 01gq rrfFtTLI(N/,/Al'I tr//l{ <br /> t q�ln/lih s�rfe li�ao5n h[t7 <br /> Received Time Dec. 19, 2017 10: 51AM No, 2763 i 1t —d7 VrDuQEe m �l eQ �j IeN�k� <br /> --- It "au,�+ltala t�q <br />