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'RECEIVE <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN ' (' 201? ENVIRONMENTAL HEALTH DEPARTMENT �� w <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 --Ji/ <br /> • ENVIIRONMEI ALFh3:';AM Telephone:(209)468-3420 Fax:(209)464-0138 Web:w Sigov.org/ehd <br /> MIT/S€WCM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mcy/� BUSINESSIAGENCY: Jp.'7trpC <br /> ADDRESS: !f(„ 5;'R,T•/ C}., / (c.ntc. tl CITYISTATEIZIP: I <br /> PHONE(1): 52 S-701- 7— PHONE(2): FAX ORE-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REODUEST-$139 FEE(C OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / iJ DATE /-/S_-j_7 <br /> 1. List up to ten addresses in the splice bel elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST lected. 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 EHO 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 fora 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From -411 to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGRomo Tmx(UST) Street# Street Name City <br /> CLEANUP SITE(LDP) ❑I:GNBUNER <br /> ......CC ) -r il,}+�t Lip <br /> OTHER CJSWATE (Nm-LOP) f H U(J c i�U .`. (11C <br /> • �HAUAODUS WASTE <br /> TIERED PERMITTED FACILITY j n ,..1 <br /> IABOVEGROUND EGROUND TANK 'J✓'••M1J (N eJICy SC+1 <br /> ,.Y'UST (MONITGRMG/REMWAL) S <br /> .rl/J,I H/SAROODS MATERIALS D <br /> }V 1"SPILL/Re-EASE RESPoNSE WATER O.TY <br /> /--Saw WASTE FACLLNY I VEHICLE , n' //� <br /> FOOD FACILm GO <br /> �,y V l <br /> POOL/SPA SOE M.TnN <br /> DAIRY <br /> LAND USE APPLIGTgN SITES <br /> ❑SEPNC PUMPER TRUCK I ❑AQWNG <br /> 8 <br /> YARO/CXEMIGL TOILETS <br /> ll WASTEWATER TREATMEST RANT GUPA <br /> H UNG ABATEMENT T <br /> MOTEUHOTEL <br /> CHICKEN RA /DDG KENNEL GUPA-Usr <br /> F1 MEDI WASTE FACILITY B <br /> TATTONSODY PIERONG SOUR WASTE <br /> WASTE TIRE <br /> 9 <br /> COMPINNT <br /> OTHEA(PLFASE SPMA): 0 ALCGtIN11XG <br /> fD <br /> -'BOXED AREA-EHD USE ONLY"' <br /> • ❑ Records provided by Staff-PPR Complete. SWffNUTw: <br /> EHD U46 <br />