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01: From:5103383192 09/07/2017 12:S1 #S7S P.001/001 <br /> � RECEIVED FILE COPY <br /> ■ DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ■ SEP 0 7 201? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1: (209)468-3420 <br /> 2 East Hazelton Avenue, Stockton, CA b:www.sjgovorg/ehd <br /> E4�IViRDNMWAL Telephone: (209)468 3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERIITISEROIDES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: 4 151 C 0h s La 1+a,n+S <br /> ADDRESS: � C' 3rd S{ic�{ CITY/STATE/ZIP: 0,k- aid CA-/ 9 4-60 _-3- <br /> PHONE (1): 2 14-0- S2 - Z o-j-`f PHONE(2): 510 - 90-4-- 314-S FAX OR E-MAIL: J key\kOLI d, t+AA- S -Cor <br /> Please allow 10 business days from date of application submittal for the records to be available. Faa : S10-375- 311 <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> 0 CHECK BOX TO EXPEDITE REQUEST-'$139 FEE(CASH OR CHECK ONLY)=REQUEST:PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT i� DATE <br /> 1. List up to ten addresses m space Blow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file tWe 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 pffly"usiness days for review. Appointments <br /> should be scheduled accordingly. 'l <br /> 4. Any file not returned in the same condition as released will b eorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$1Z deposit prior to review. r �1 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) t <br /> Electronic Information: List g Map-Description: <br /> Specific Date Range of Information Requested: From 0 l at s to c L'\V-V-�V'� <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENTFILE ADDRESS <br /> EHD USE ONLY <br /> FILES I <br /> UNDERGROUND TANK(UST) I Street# Street Name City <br /> CLEANUP SITE LOP ((� P ( CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) <br /> AUaRDOUS WASTE 6 <br /> 44TIERED PERMITTED FACILITY L�'414 <br /> tv0'�t <br /> WAaOVEGROUND TANK <br /> rST (MONITORING/REMOVAL) �f00 <br /> 74V'!, <br /> VG <br /> 0 PWS <br /> KHAZARDOUS MATERIALS 3 <br /> a r a 10✓ <br /> 9,S11' <br /> PILL/RELEASE RESPONSE <br /> i - <br /> OLIO WASTE FACILITY/VEHICLE I I ^ I �A �'a I' WATER QUALITY <br /> �(FOOD FACILITY Il- (A/I OGt <br /> (�I POOL/SAA [g'6ITE MnIGATION <br /> DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> 6 I IHOUSING <br /> SEPTIC PUMPER TRUCK/ <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT t C'UPA <br /> HOUSING ABATEMENT T �- pY'1bd <br /> MOTEL/HOTEL l r MT <br /> CHICKEN RANCH I DOG KENNEL q11\ `� [O CUPA-UST <br /> [�( MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING I / <br /> WASTE TIRE CKOUD WAS-M <br /> COMPLAINT <br /> E]OTHER(PLEASE SPECIFY): I I I I ` , <br /> AccouNrwG <br /> fo <br /> —BOXED AREA-EHD USE ONLY— <br /> few G�"�"l� �� L<< r<' , Ccs tiE✓ ;eclLt� 1) �"AA �..�.�:;✓�. �►". c F la�;L. L Lto (4e%.- Qe­% ��-- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> END 4846 <br /> Received Time Sep, 7, 2017 12 :44PM No, 2245 <br />