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RECEIVED <br /> S A NJ OA Q U I NIAY 2 5 1018 Environmental Health Department <br /> C O U N T Y Atx,�.�,) PUBLIC RECORDS RELEASE APPLICATION <br /> lTIION <br /> IC <br /> • �ftT dIT BY EMAIL v V <br /> EHD LOG NUMBER: LL/// S <br /> APPLICANT: N}4,l�bl f'l llu,vR.� BUSINESS/AGENCY: Ttv7-A.WA <br /> ADDRESS: 102I E. NaI A+!!AAy.- CITY/STATEIZIP; S490441grk-f CA- 9SZ.03 <br /> PHONE(1): Lylm)2t/or-Sb1)j PHONE(2): FAXORE-MAIL: f'it,an.DA.tK.Ln(a-)triatvA. <br /> Please allow 10 business days from date of application submittal for the records to be available. cc <br /> Staff will contactou to arran an a ointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT y n= ATE S-2S-18 <br /> 1. List up 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(209)464-0138,mail to the <br /> address indicated below,or email to infoOsicehd.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 len(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. �l <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 to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Twit(UST) Street# Street Name City <br /> Cleanup Site(LOP) D comauusa <br /> XOther Cleanup Site(Non-LOP) ' 1021 E• f+A;be r'% gJ .KV-0- Sd'v(kkn+� F r <br /> • Hazardous Waste H'"INy�SM Lip D DI <br /> nered Permitted Facility ' 1633 e• S(.�Tif IQ,rf�/-t.. `�Vu'^"�' <br /> Aboveground Tank T <br /> UST (Monitoring/Removal) G�/ D PWS <br /> Hazardous Materials S !3� S(p{{if• <br /> Spill/Release Responsee <br /> NS\,,Lin 'n �1iW w,rea ouum <br /> Solid Waste Facility/Vehicle aVhiO✓l f')1�Q.� <br /> f�LstOn VC ' / /'T <br /> n Food Facl'ity k/V <br /> []pool I Spa t+r}tt�'1 LWine Mini <br /> Land Use Application Sites <br /> Septic Pumper Truck/ NM uaT SM D HOUSING <br /> a (p3S S. i}U✓Df0. mit-t f I D(IcstoY� F` <br /> k_,,,Y'a'rd/Chemical Toilets <br /> Aw / <br /> asteivater Treatment Plant N•Y . UPA <br /> Housing Abatement T AST/HM/HW <br /> E]MolellHolel <br /> n Chicken Ranch/Dog Kemrei CUPA <br /> 9 UST <br /> Medical Waste Facility <br /> ❑Tattoo/Body Piercing ouo AIWE <br /> Waste Tire e <br /> Complaint <br /> C]Other(Please Specify): D AccouN.ms <br /> io <br /> —BOXED AREA-EHD USE ONLY'-' <br /> y Ei(r <br /> • ❑ Records provided by Staff-PPR Complete.staff Name: EHD 4606 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 mww.sjcehd.com <br />