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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> cNVIRONMENTAL HEALTH DEPARTM J,. LE C <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 zo <br /> � <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: krando, 1001-) BUSINESS/AGENCY; f7M nV1W1111'y1�1rA <br /> ADDRESS: 40 (AA(A.ja S O V JEE200 CITY/STATE/ZIP: rl lie, <br /> PHONE(1): ( I(D)U17- 2(670 PHONE (2): FAX OR E-MAILWAQpmeA'_,6or0 <br /> Please allow 10 business days from date of application submittal for the records to be available. 1 <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space 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 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 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 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: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City (� <br /> LEANUP SITE(LOP) 2 '``P� .p�',(,� k CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) 9 94 O J "y �v`� t' v0 � <br /> HAZARDOUS WASTE * <br /> ®TIERED PERMITTED FACILIT2 ��� ,VVI ! V <br /> � " DAIRY <br /> V c <br /> ABOVEGROUND TANK <br /> (/�✓��/tY 1 �(•J"-�,', V V <br /> UST (MONITORING/REMOVAL) V PWS <br /> HAZARDOUS MATERIALS 3 y� <br /> U ,�q <br /> ova✓� b h� �v.,\ r� <br /> SPILURELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE <br /> � � !/ <br /> WATER QUALITY <br /> FOOD FACILITY 0-0 ''.343 41 YiVe, u('D_r) <br /> POOL/SPA <br /> SITE MITIGATION <br /> DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ HOUSING <br /> B <br /> YARD/CHEMICAL TOILETS ` <br /> ASTEWATER TREATMENT PLANT y CUPA <br /> OUSING ABATEMENT 7 ` <br /> OTEUHOTEL <br /> HICKEN RANCH/DOG KENNEL n CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> i I <br /> TATTOO/BODY PIERCING <br /> SOLID WASTE <br /> ASTE TIRE 9 \ <br /> OMPLAINT \ <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> """BOXED AREA-EHD USE ONLY"`" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />