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EME RLUBVEty No, 0410 P, 1/1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> r.., 7 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.Sjgov-org/ehd <br /> PERMITESE9V.ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v[L_n BUSINESS/AGENCY: l�n�/1 ro,�meM <br /> ADDRESS- ),�— a (-C-4(j ,. c tr4it CITY/STATE/ZIP: <br /> PHONE(1); PHONE(2): FAX OR E-MAIL: Gl re(� P.f` fi br <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 130X TO EXPEDITE REQUEST- E (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9-1-1-7 <br /> 1. List up to ten addresses in the sp ce 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 seloctod. 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 then no d a .1% <br /> C <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for review w111 be confirm d o na (10 <br /> days after recelpt of application. The flies will be held for a maximum of five business days for reew.-A olnE e <br /> Y pp m nts <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 requite 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 to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD US,E ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name city 6 <br /> CLEANUP SITE(LOP) /pI7� c �c�I El CONSUMER <br /> VC C/ Iv�/� i V <br /> O7NER CLEANUP SITE(NON-LOP) Q <br /> HAZARDOUS WASTE ���JJJ l(/��'��// (� -•I( �/ �,/ ❑DAIRT <br /> TIERED PERMITTED FACILITY 2 f LkL <br /> �q..� l�'�G� � ` I r{T(A80vroR0UND TANK / G`,, V7 ! ^1 �� <br /> IST (MONITORING/REMOVAL) py_ 1``�JA 1 /� � ❑PWS <br /> AZARDOUB MATERIAL& <br /> SPILORELEASE RESPONSE WATEOODAGIL)TYR QUALITYOLID WASTE FACILITY/VEHICLE n n/�P <br /> POOL/SPA <br /> DAIRY <br /> 10 5 <br /> RAND USE APPLICATION SITES (J <br /> J-1 SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> e <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT COPA <br /> ❑HOUBING ABATEPAE14T 7 <br /> ❑MOTEL/KOTEL <br /> ❑CHICKCN RANCH/Doe KENNEL ,,n VUPA-UST <br /> l]MEDICAL WASTE FACILITY 13 N <br /> TATTOO/BODY PIERCING \ <br /> WASTE TIRE N(Souo WAeTE <br /> e /N <br /> COMPLAINT <br /> OTHERIPLEASE SPECIFY): ❑ACCOUNfINO <br /> iD <br /> =kocords <br /> 20XED ARPA-RHP USP ONLY'--by Staff-PPR Complete. Staff Name: <br /> Received Time Aug, 1, 2017 2: 59PM No- 2016 <br />