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DAIVLD^I VE EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> A( 14 201ENVIRONMENTAL HEALTH DEPARTMENT C / <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 J \/(n/ <br /> 112"ANMIrNTAL HEAD .TFiTelephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> 0 <br /> PEAMrr/$ER%*M3 PUBLIC RECORDS RELEASE APPLICATION <br /> •APPLICANT: ` ' c�+ Brryrd ^ i � BUSINESS/AGENCY: /3wC,4' <br /> ADDRESS: J !.1/ G/ed�/f SF-- s Z— CITY/STATE/ZIP:,r�f' c� �/_ J¢ g <br /> PHONE (1): �jQ_q ' 0!� �GZ 9 PHONE (2 10V VGC,-63Z?FAX OR E-MAIL: r, �l�EV�i�.>/ <br /> Please allow 10 business days from date application submittal for the records to be avai ble. C:_O/L . <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(CAS CHECK O )-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE .5 -- /"43 <br /> 7. List up to ten addresses in the space ow. elect he type(s) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUS a selecte Fax to!2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applicatl ed 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DLESRTMENT FILE ADDRESS EHD USE ONLY <br /> UNDERGROUNDTANK(UST) Street# /� Street Name City <br /> C UP SITE(LOP) z '00W40 O F1 z$-O,f / /�/) 1 ..o_ Lo 0 CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) w <br /> ❑HAZARDOUS WASTE !•`-- !T <br /> DNRY <br /> TIERED PERMITTED FACILITY 2 <br /> ❑ABOVEGROUND TANK Iyv .I�MJ- 3IZ2 <br /> FjUST (MONITORING/REMOVAL) ✓�I ❑Pw$ <br /> HAZARDOUS MATERIALS G <br /> SPILURELEASE RESPONSE <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 WATER QVAUTY <br /> ❑FOOD FACILITY <br /> E]POOL/SPA USirp MITIGATION <br /> DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ B 11 HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT E]CUPA <br /> HOUSING ABATEMENT 7 <br /> ❑MOTELMOTEL <br /> CHICKEN FLINCH/DOG KENNEL ❑CUPA-LET <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING <br /> SOLID WASTE <br /> ❑WASTE TIRE g <br /> ❑COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): EI ACCOUNTING <br /> 70 <br /> -'BOXED AREA-EHD USE ONLY- <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />