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No, 0410 P. 1/1 <br /> r DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> '��`�'6 0 1 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 0WMN LALW--NLTH Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERMITfSEROGIE i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v(Lo HU81NES5/AGENCY: lz: EAi rorlt-1 11 <br /> ADDRESS: 15 feE c �,. G Lj CITY/STATE/ZIP: <br /> PHONE(1): SIO-�I'I'7-1$t3S`x,30 PHONE(2): FAXORE-MAIL: <br /> Please allow 10 business days from date of application submittal forthe records to be available. <br /> Staff will contact you to arrange an appolntment date and time to revlew the requested records. <br /> HECK BOX TO E=XPEDITE=REQU ST W F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 09-1—1-7 <br /> 1. list up to ten addresses in the spgce 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(2091 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 conflrmItA <br /> o�ma� <br /> opy <br /> days after receipt of application. The files will be held for a maximum of five business days for re e oln <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 /> Puture file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELT_AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) v/ I <br /> Electronic Information: Q 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 U 1 <br /> CLEANUP SITE(LOP) (\'j (\� /5 !� ❑CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) st�OV�.7- <br /> HAZARDOU3 WASTE /' ❑ <br /> 1�-���� ��� DAIRY <br /> TIERED PERMITTED FACILITY 2 1 <br /> EST ABOvEGROUNO TANK R <br /> /�-'-UST (MONITORING/REMOVAL) �� p 1\ 1 n3 ❑PW& <br /> U <br /> ARDOUB MATERIALS <br /> � ,�,+"C1}--���' <br /> SPILURELEARE RESPONSE <br /> l r \ // <br /> OLID WASTE FACILITY/VEHICLE n WATER QUALITY <br /> FOOD FACILITY "11 <br /> ❑POOL/SPA <br /> O L \ ..ITE MITIGATION <br /> DAIRY <br /> XI.AND USE APPLICATION SITE& <br /> !E]SEPTIC PUMPER TRUCK/ ❑HOUBINa <br /> e <br /> YARD/CHEMICAL TOILETS <br /> T <br /> WASTEWATER TREATMENT PLANT � <br /> F-1HOUSINGHOUSING A&kTEMENT <br /> MOTEL/HOTEL <br /> s <br /> ❑CHICKEN RANCH/Doe KENNEL ^ UPA-UST <br /> n MEDICAL WASTE FACILITY <br /> N <br /> O'rATTOO/BODY PIERCING ,n�J <br /> 9 1` SOLID WAeTE <br /> WASTE TIRE (;KLCOMPLAJNT <br /> ❑OTHER(PLEASE SPECIFY): ❑AGL'OUNTINO <br /> iD <br /> "'60XFD ARFA-EHD USF ONLY"' <br /> r 0 <br /> IT <br /> • L4� I^ �� -� t..a_ 1fQL+F.IJ` "Ch2 .t GI/�l �i sn`�.:^ � ^i^u �- e=G�l��f y1 <br /> Y <br /> LJ Records provided by Staff-PPR Complete. Stiff Name; <br /> Received Time Aug. 1. -2017- 2 : 59PM No, 2016 <br />