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SANc10A UINRECEIV� <br /> Q pronmental Health Department <br /> —COUNTY— rvL'V Q ! 201f PUBLIC RECORDS RELEASE• APPLICATION- Greatness grows here.ENVIRONMENTAL <br /> PEQMFrAEffiR^MEHD LOG NUMBER: 9747S <br /> APPLICANT: ¢ S0 C BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE(1): rj/7)' `J1S > ONE(2): FAX OR E-MAIL: Allidk]a , <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange anproi tment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT �i;,6 --� �{ DATE Jf/ J .L e/ <br /> 1. List up to ten addresses in th a below.gess 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(aDsicehd.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 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$152 deposit prior to review. (j <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00131111(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map–Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> lG <br /> • �U <br /> nderground Tank(UST) Street# Street Name City <br /> Site(LOP) <br /> coasu.en <br /> VCother Cleanup Site(NorrLCP) A5C N-MdSccAbnDA T�p rl /w <br /> -ffHarardous Waste <br /> /yrV�/',q( r/a r, f�tA/ .re ,ff/��/ <br /> ❑ �1 r ��1'Ilr -1 -�' ISI` ,v`l/�✓� /✓ 1 ❑DAIRY <br /> Tiered Permitted Facility R <br /> Aboveground Tank <br /> ST (monitoring/Removal) a ���� �'/ l�ry �� ` r��„ �,r„ ❑PWS <br /> azartlous materials <br /> Spill/Release Response �I <br /> Solid Waste Facility/Vehicle _ WAR Ceµm <br /> ❑Food Facility I'Mrr1"/11 <br /> ❑Pool/Spa Sns m aAlmon <br /> ❑Dairy 5 <br /> ❑Land Use Application Sites <br /> ❑Septic Pumper Truck/ 6 13 H siw <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant cppA <br /> ❑Housing Abatement r ASTIHM/HW <br /> ❑Motel/Holel <br /> ❑Chicken Ranch I Dog Kennel uPa <br /> ❑Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing "" <br /> ❑souo Wnsis <br /> ❑Waste Tire e <br /> ❑Complaint <br /> ❑ <br /> Other(Please Specify): ❑Accouniins <br /> to <br /> 'BOXED AREA•EHD USE ONLY*" <br /> • <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD asa6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />