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6 <br /> ��6�" --G� ��� <br /> � � g 1�� & XyU&�����, U=H�� �~��l�~�����entaK Health �������8�m���nt <br /> � ^~,"` . ~ =".= ~. " ,° ~ <br /> RELEASE APRLICATION <br /> ' <br /> ENVIRONMENTAL HEALTH, <br /> EHD LOG NUMBER: <br /> ADDRESS: 520 CITY/STATEIZIP: Oakland, CA/94607 <br /> PHONE (1): PHONE(2): FAxoRE-RImL <br /> Please allow 1Obusiness days from date of application submittal for the records to be available. <br /> Staff will contact you toarrange onappointment date and time tonmiawthe requested records. <br /> SIGNATURE OF APPLICANT DATE Jui on zo10 <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(a-)sjcehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned x/the same condition""released =' "='="'y"^'^~" ~, ^''Dstaff~^the expense~ ^^~~,,^`~^^ . �7 <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:0OAM'5:UOPM(EXCLUDING HOLIDAYS) ~ <br /> Electronic information: El List[_1 Map—Description: _771 <br /> Specific Date Range of Information Requested: From all to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT \. EHD USE ONLY <br /> FILES pecific addresses only,address ranges will not be accepted) <br /> Underground Tank(UST) Street# Street Name C ity E]CONSUMER <br /> Cleanup Site(LOP) 4239 Newton Road Stockton <br /> FX]Other Cleanup Site(Non-LO t'A'k <br /> Hazardous Waste 11-AfAlAdAw 6DAIRI <br /> Tiered Permitted Facility 2 4301 Newton Road Stockton Irl fill <br /> Aboveground Tank FIL E]PWS <br /> LIST (Monitoring I Removal) <br /> Hazardous Materials <br /> P9 Spill/Release Response &KNATER QUALITY <br /> Food Facility <br /> Pool/Spa n4TE MITIGATION <br /> F-]Dairy <br /> Land use Application Sites <br /> Septic Pumper Truck 6 <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant <br /> F-]Housing Abatement 7 AST/HM I HW <br /> P9 Motel/Hotel U;n—P, <br /> rj Medical Waste Facility <br /> F]Tattoo/Body Piercing WASTE <br /> P71 Waste Tire 9 <br /> Complaint <br /> Other(Please Specify): AccouNTING <br /> 0 Records provided by Staff-PPR Complete. Staff Name: EHD48-06 <br /> 18S8E. Hazelton Avenue I Stockton, California A52U51 T 2O9488-342O1 F 20S484'0138 1 www.sjuehd.com <br />