Laserfiche WebLink
RECEI 13 <br /> SAN JOAQUINt1AY 25 2018 Environmental Health Department <br /> COU '"6nnRo&*WA.F+rMM PUBLIC RECORDS RELEASE APPLICATION <br /> • F'FllAllITfOW ' IT—E'i"EM L `2" 73 <br /> EHD LOG NUMBER: <br /> APPLICANT: "t,GJA*A Dw /L:j BUSINESSIAGENCY: '1Z1'T'rA./Avt <br /> ADDRESS: 1021 E. Na-4-t1 yvi. Fyuiv-e- CITYISTATE/21P: 44yckA%r),, CA- 9S-7P3 <br /> PHONE(1): L91tg)Z4(0 -Sb9-+ PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. (AM <br /> Staff will contact youto arrany�an a ointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT :M DATE S--L5--18 <br /> 1. List un to ten addresses in the space below, Address 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(2091464-0138, mail to the <br /> address indicated below,or email to info(Dilsicehd.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 8152 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 FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank LUST) Street# Street Name city <br /> Cleanup Site(LOP) ❑Co... <br /> • <br /> W Other Cleanup Site(NoniOP) 1 1 OL1 �, RARA*r\ A4(AV-0. �t�vWr •� r Ix <br /> Waste ({.1.t�tyT 5M �p p Daar <br /> ❑Twred Permitted Facility z f033 G. 5,- fT Av"� `�t,y�� <br /> Of <br /> Aboveground TankIn J G WT! tN"� <br /> UST (Monitoring(Removal) r'tlEtf''l t1�T PWs <br /> 'I Hazanlous Materials I JS 5(,p�t'.}' V_e 'Nati.(-on <br /> ItWO'�I'Spill I Release Response u S7 a <br /> Q -Solid Waste Facility I vehicle 4 ! t• <br /> Ip �(Il Wa�+Ou^+m <br /> Food Facility st <br /> f'II� " L(,ILi{'e <br /> Pool l Spa AA��� NYtr 5� SrrE Mmwnox <br /> Dairy S ` 0t) aT. fill✓(I rGI 1+-r4-4- PALWOR <br /> ❑Lend Use Application Sites <br /> Septic Pumper Truck 1 Hl x u4-r 4Nt [3HOUSING <br /> Yard I Chemical Toilets / S ��� S. F�UVG ra --I" f'YDL1�'o✓� F <br /> Wastewater Treatment Plant N•Y UPA <br /> �❑Housing Abatement i AST/HM/HW <br /> ❑Motel/Hotel <br /> Chicken Ranch I Dog Kennel COPA <br /> 8 UST <br /> Medical Waste Facility <br /> ❑Tadoolaody Piercing MrtOUGWXSTE <br /> Waste Tire a <br /> ❑Complaint <br /> ❑Other(Please specify): ❑Accouxima <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY— <br /> Ann. - -.rnZ -Tte G4c"' <br /> • ❑ Records provided by Staff-PPR Complete. staff Name: EHD 48.06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />