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RECEIVED RUSH <br /> DATE RECEIVED tt�� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN 16 2017y ENVIRONMENTAL HEALTH DEPARTMENT n <br /> 1: (2 East Hazelton Avenue, Stockton, CA b:www.sigov.org/ehd <br /> • LNViRONMFTi fAl Frelephone: (209)468-3420 Fax: (209)464-0138 Web:wwwsjgov.org/ehd <br /> PEIU4JIT/SE4V(�..T.3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t/l,j BUSINESS/AGENCY:/y,�p <br /> ADDRESS: (✓ CITY/STATE/ZIP: �LNhS ✓p G/ j- <br /> PHONE(1): - /j-- PHONE(2): FAX OR E-MAIL: �folrNu�`'] <br /> lease allow 10 business days from date of application submittal for the records to be available. <br /> f Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG OF APPLICANT DATE <br /> 1. List uo 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-5:00PM(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 USE ONLY <br /> %UNDERGROUND TANK(UST) Street# Street Name /.J1�j/ciity II <br /> • CLEANUP SM(LOP) , QZ r L'1f(A k �k X G NI IV 'n ❑CDNSUUER 13 <br /> �ORIER CLEANUP SITE(NON-LOP) I O r J /'fit f 1]J <br /> rl HAZARDOUS WASTE +1 '/ /I / / J fT C]DK'R' <br /> Fj TIERED PERMITTED FACILITY 2 It �i( }(,.r/ �y )k <br /> ISI.ASOVEGROUNO TANK <br /> �I UST (MONITORING/REMOVAL) �, o N IO Lo V Rt!n,C}y ._ L)' ❑PWS <br /> HAZARDOUS MATERIALS f <br /> •-Y� SPILURELEASE RESPONSE r o K F/r n <br /> � LOP LC) Ij WATER DUALITY <br /> ❑SOLID WASTE FACILITY l YEXILLE , I� IINN -_ •` <br /> ❑FOOD FACILITY Tp <br /> ❑POOLISPAQ�G } r -,�e -Lo S <br /> �(I..�� wire MIICATON <br /> ❑DAIRY 5 h No ✓� -"Y ✓ rl�X106 Qr�„ � CID <br /> 1LAND USE APPLICATION SITES /_ / /// <br /> r-1SEKIC PUMPER TRUCK/ f6 A44 NI j—_ %in <br /> I q10 1 <br /> ❑HDUSIrvG <br /> YARD I CHEMICAL TOILETS Pli� rf�ux� �� t���-� <br /> ❑WASTEWATER TREATMENT PUNT [ ( COPA <br /> r ' NDN <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTELMOTEL ih J Y <br /> E]CHICKEN RANCH/DOG KENNEL f J1 // L(G�� CUPAUST <br /> ❑MEDICAL WASTE FACILT' ta�r..1 ( <br /> ❑TATTOO/BODY PIERCING ft 0. SGlIO WASTE <br /> ❑WASTE TIRE I / �/r•tall ❑ <br /> 9 /L Vn <br /> ❑ <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): / / ❑Aoc..,rtlN,, <br /> �6, <br /> "'BOXED AREA-EHD USE ONLY"' <br /> • <br /> ❑ Records provided by Staff-PPR Complete. Staff Nam.: <br /> EHD4846 <br />