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From:5103383192 7/2017 12:51 #575 P.001/001 <br /> r: RECEIVED FILE COPY <br /> ■ ■ DATE RECEIVEDEHD LOG NUMBER <br /> ■ SEP G 7 201? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ElY1/1F40j AL llM Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd � <br /> IPERMIT/59WES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: 4 Et I oN Su)-{-gA+S <br /> ADDRESS: � o CITY/STATEIZIP: O•kla�d C 1 `�4 b d <br /> PHONE (1): Zy-p- }S2 - 2 o T`( PHONE(2): SIy - q0� - 3145 FAX OR E-MAIL: �hev�kai�AGi ConS1A f+An{S •Go� <br /> Please allow 10 business days from date of application submittal for the records to be available. rAx : 510-338- 319 <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> El CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY),-.REQUEST:PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE `( /-T// -77- <br /> 1. List up to ten addresses in space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one He 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 maxi um of five business days for review. Appointments <br /> should be scheduled accordingly. j o <br /> 4. Any file not returned in the same condition as released will reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a 1,09 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FORREVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: List gmap-Description: <br /> Specific Date Range of Information Requested: From 01445 to C v,vV tt <br /> ENVIRONMENTAL <br /> HEALTHDRTMENT FILE ADDRESS <br /> LESEHD USE ONLY <br /> KUNOERGROUND TANK(UST) Street# Street Name city <br /> CLEANUP SITE(LOP) CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) ' <br /> �C I NA7ARDOUS WASTE 16 - <br /> t-�2 <br /> ,y TIERED PERMITTED FACILITY 2 I�]J I M�,/I��l✓� P0. �l W(ti fi�v Q <br /> 1�"1C1ABOVEGROUND TANK <br /> PST (MONITORING/REMOVAL) CIA <br /> a <br /> 1G �V ✓T -C"10 <br /> ❑PWS <br /> — HAZARDOUS MATERIALS 30O <br /> ErSPILL/RELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE I I n ry �A `O "� QL W I WATER QUALITY <br /> ,..K{F000 FACILITY <br /> ISI POOL/SPA [!2ITE MrTIGATION <br /> DAIRY S <br /> LAND USE APPLICATION SITES <br /> �i SEPTIC PUMPER TRUCK/ HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTEUHOTEL MT <br /> CHICKEN RANCH I DOG KENNEL OCUPA-UST <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE t OLID WASTE <br /> 9 <br /> COMPLAINT <br /> 1]OTHER(PLEASE SPECIFY): <br /> ❑ACCOUNTING <br /> 10 <br /> -r '-'aOXED AREA•EHD USE ONLY"" t <br /> (1-7 -,J�C I .C ,r C` .%�'a1 CGL; 4'i- is.�a n {� ` i ff `-r �..( t�•'y' <br /> I . <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> END 4B-06 <br /> Received Time Sep, 7, 2017 12 :44PM No, 2245 <br />