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DA II'�fPE OG NUMBER <br /> F SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ///�yy��� <br /> DEC f �I k7 1868 East Hazelton Avenue, Stockton, CA 95205-6232 " " 1 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd L 2, <br /> 3• <br /> AL FIEfLLT PUBLIC RECORDS RELEASE APPLICATION / r� <br /> APDL ,4VICES Lam. t'M� <br /> BUSINESS/AGENCY: <br /> ADDRESS: 1(16 S a a pr CITYISTATE/ZIP: Mbacsio rA 01' � <br /> PHONE (1): 2a°l '3�1 -U la$ PHONE (2): ( o^t- Hall-3iIS FAX ORE-MAIL: Q�� ttip.��m2.to <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 /> CHECK BOX TO EX REQUEST $13 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /, DATE 12/221 !a <br /> 1. List up to ten addresses a space el w. 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 It 0) <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-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map- Description: <br /> Specific Date Range of Information Requested: From to <br /> FR <br /> IRONMENTAL <br /> H DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> GROUND TANK(UST) Street# Street Name City <br /> UP SITE(LOP) SIU rte , /I/� 0. ` `, /NO n/ G� ` Cl CONSUMER <br /> 3 1 / L Jl '` Y P R�ilo 5 - o <br /> CLEANUP SITE(NON-LOP) <br /> 005 WASTE ❑DAIRY <br /> PERMITTED FADILITY ]ROUND TANKPWS <br /> MONITORING/REMOVAL) pDOUS MATERIALS r.,,j`_\ coELEASE RESPONSE ^VWu��M WpTeR Ounutt <br /> SOLID WASTE FACILITY/VEHICLE q <br /> ❑FOOD FACIUTY <br /> POOL/SPA <br /> SITE MITIGATION 1`1 <br /> F­I DAIRY S /-'r_Jry/W/(•.VI`,r <br /> r-1 LAND USE APPLICATION SITES 11 HOUSING <br /> ❑SEPTIC PUMPER TRUCK( 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> HOUSING ABATEMENT 7 <br /> ❑MOTELIHOTEL CUPA-UST <br /> CHICKEN RANCH/DOG KENNEL <br /> B <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING SOLID WASTE <br /> i�WASTE TIRE 9 <br /> COMPLAINT <br /> 01 OTHER(PLEASE SPECIFY): Ac WONTING <br /> 0 <br /> ""BOXED AREA_-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />