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HLULIVEty No. 0410 P. 1/1 <br /> r DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUb 0 1 2017 <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazoltcn Avenue, Stockton, CA 95205-6232 <br /> RNVR0NWr - Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PEMITfSIERO .ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: HUSINESWAGENCY; � � !1/11/1 foylmeM <br /> ADDRESS: is a c��N� oma, G' -411 CITYlSTATE/ZIP:�y�/(ur ,rJ,, (� �!�(.,t—�•f( <br /> PHONE(1): SIO-�1'I'7-9$$,�, 0 PHONE(2): FAXORE-MAIL: q re1�� tl�aks, bre <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 /> HECK BOX 70 EXPEDITE REQUEST- H (CASH OR CHECK ONLY) REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S-1 1-7 <br /> 1. list up to ten addresses in the sprce below_ Select the type(s) of files from the list below by checking(the appropriate <br /> box(es). At least one file type MUST b©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 p Lllmly 0 <br /> days after receipt of application. The flies will be held for a maximum of five business days for revieer ;" <br /> �+I' <br /> should be scheduled accordingly. <br /> 4, Any file not returned in the same condition as released will be reorganized by LHD staff at the expense of the applicant, <br /> Future fila 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) I <br /> Electronic Information: t] List❑ Map—Description; <br /> Specific Date Range of Information Requested: From 77= to <br /> FNVIRONMLNTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City (� j <br /> CLEANUP SITE(LOP) I ^r /I Q ❑CONSUMER <br /> O7NER CLEANUP SITE(NON-LOP) i EL' <br /> HAZARDOUS WASTE <br /> El DAIRY <br /> G \/J <br /> C W' <br /> TIERED PERMITTED FACILITY 2 AIr ^^^111 <br /> AAAOV9QROUNo TANK n <br /> UST(MONITORING!REMOVAL) �� p 1\ L� /�(� /� J� ❑PWS <br /> AZARDOUB MATERIALS 7 <br /> (tir I • <br /> SPILL/RELEASE RESPONSE / ,r <br /> WATER QUALITY <br /> OLID WASTE FACILITY!VEHICLE A n n �� `(�� [\i r <br /> FOOD FAGLtTY (JJ'/l-'- Il/v/1 <br /> POOL/SPA <br /> O 1 vITE I�AIYGAYlo11 <br /> DAIRY 5 <br /> XLAND USE ARPUOATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑HOUSIND <br /> e <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT u A <br /> HOUSING AaATEMENT 7 <br /> MOTEIJHOTEL <br /> CHICKEN RANCH/DOG KENNEL ^ UPA-UST <br /> MEDICAL WASTE FACILITY <br /> F]TATTOO/BODY PIERCINe 'V - <br /> Y4WASTE TIRE r SOLID WASTE <br /> C(Z <br /> COMPLAINT <br /> F1 OTHER(PLEAOE SPECIFY): D ACCOUNTING <br /> �o <br /> (` •"6QXFP ARFtAi-EHP USE ONLY"'® t <br /> _ Ul l 1�i� -� (i..'+_ m&,,t z .ce l �i s�`�s^ (J '6^u G ertl�a TYA.IT <br /> y►'o� <br /> 0 Records provided by Staff-PPR Complete. St,ffNoma; <br /> Received Time Aug. 1. 2017 2 : 59PM No, 2016 <br />