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D/RRECE CED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTME. <br /> JAN 16 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 We�sj�v.o <br /> I'�IMRUNMEAfT&H SN t}}��11 <br /> ,��,,,. 'Gr-,,at!" PUBLIC RECORDS RELEASE APPUU4 <br /> APPLICANT: "Cto BUSINESS/AGENCY:- <br /> j <br /> ADDRESS: -q5 q YVWAve Si e, l)� CITY/STATE/ZIP: fres 0 6f{ 3 2Z <br /> PHONE (1): (55q '2y9-- 5t (p PHONE (2):(9")2�7(p—g5ll )()-II FAX OR E-MAIL: rcOhfn( Whni(W,Yi�it <br /> Please allow 10 business days from date of application submittal for the records to be availab e. <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 I <br /> X UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) <br /> 1 / _Ur ; / l nRi AYe <br /> OTHER CLEANUP SITE(NON-LOP) 13!/1 J 'v L IY Il 111 999 A/�rry 1�� / <br /> HAZARDOUS WASTE ,' <br /> TIERED PERMITTED FACILITY z 55 N Lin G0 in �� � M an�G w ABOVEGROUND TANK <br /> MUST (MONITORING/REMOVAL) I ((�r� /p�q�\/HAZARDOUS MATERIALS `� V, lvv�� 1 ' YSPILURELEASE RESPONSE <br /> SOLIDWASTEFACILITY/V H 4 W36 � Lin(,01n ft Vel �F-e�,�i, Et Ej FOOD FACILITY 1` IIIIYYYY � <br /> POOL/SPA 5�SITE MITIGATION <br /> DAIRY 5 �/`i 1 V V , °'l.l �� �1 Y •- <br /> (�/��,i U/�I.n ut <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ B e 0 '��J^I -� I1� `j HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT ^ N CUPA <br /> HOUSING ABATEMENT 7 't't�b MOV (S� ILJI onWA <br /> MOTEL/HOTEL VVV 111 ll <br /> CHICKEN RANCH/DOG KENNEL [16 CUPA-UST <br /> 8 <br /> F]MEDICAL WASTE FACILITY <br /> TATTOOIBODY PIERCING <br /> I(SOLID WASTE <br /> WASTE TIRE B <br /> �.COMPLAINT i <br /> F]OTHER(PLEASE SPECIFY): E]ACCOUNTING <br /> 10 <br /> W.4DP01-EHD USEONLY*** <br /> K:t <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />