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HLULIVELY No, 0410 P. 1/1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ■■ Ft:6 0j2017 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ■ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> TH <br /> '�- , Telephone: (209)468-3420 Fax; (209)464-0138 Web:www.sjgov.org/ehd <br /> l ERMITISER DICE i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: hi VCY0% BUSINESS/AGENCY: �l�.S 11n1/1'�orlmeM <br /> ADDRESS: {� $ r•� �,. _ Gqr4i j CITY/STATE/ZIP: <br /> PHONE(1); S jp-fir I'7-1$8S`-x„30 f).. PHONE (2). 61-2�-" 3')J`-9q�6 FAX OR E-MAIL: A rQW <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- (= (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9-1—I� <br /> 1. List up to ten addresses in the spice 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 busing <br /> 2. For assistance in Identifying the nature and content of EHD records, please contact EHD at the pubo ab <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approx mate flten <br /> 10) <br /> days after recelpt of appllcatlon. The f1les 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: Froth to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City Ab/ii, <br /> CLEANUP SITE(LOP) J� /1 �i ^' ^/ n `� CON3UAfER <br /> O7kER CLLANUP SITE(NON-LOP) <br /> HAZARDOUS WASTE (((�����o /� DAIRY <br /> TIERED PERMITTED FACILITY �j <br /> I <br /> ABOv6GROUND TANK UST (MONITORING/REMOVAL) <br /> p <br /> AZARDOUS MATERIALS U -7� ❑ <br /> PWS <br /> SPILLIRELE."E RESPONSE I/ <br /> l f �/ <br /> OLID WASTE FACILITY!VEHICLE A n/1 n WATER QUALITY <br /> �IOOD FACILITY "11 /-1 ,l/•l!I 11/1, <br /> SIT <br /> e <br /> POOL/SPA '�`{ <br /> ' <br /> ` G /XC, E MIT71o+1 <br /> l�DAIRY 5 O <br /> rl <br /> LAND USE APPLICATION SITES <br /> 7❑'SEPTIC PUMPER TRUCK/ ❑HOUBINa <br /> e <br /> YARD!CHEMICAL TOILETS <br /> r <br /> WASTEWATER TREATMENT PLANT UPA <br /> F]HOUSING ARATEMENT 7 <br /> MOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL Ek6UPA-UST <br /> E]MEDICAL WASTE FAG0.ITY 6 <br /> 171 TATfDOIBODY PIERCING A-I" <br /> 39WASTE TIRE r ` soLw wAeTE <br /> B r� <br /> COMPLAINT <br /> F]OTHER(PLEASE SPECIFY): Il AGGOUNTINO <br /> iD JE7 <br /> p ` ---SOXFD ARRA-PHP USP ONL <br /> (d f• (y <br /> _ I V �C l<— �Qf C:lv' 'L .r�. Gl/`rJl ri w t`2�� l.� 'tnu e- e-JY 1l F Hyl <br /> IT <br /> Cd Records provided by Staff-PPR Complete. Staff Name; <br /> Received Time Aug, 1, -2017— 2: 59PM No, 2016 <br />