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CEIV D • <br /> SAN J O A Q U I NAR 3 Q 201 Environmental Health Department <br /> COUNTY PUBLIC RECORDS RELEASE APPLICATION <br /> PEPWRiry/1L <br /> ��iy EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: fongchea BUSINESSIAGENCY:waterlooliquors <br /> ADDRESS: 2512 waterloo rd CITYISTATEOP: kton ca 95205 <br /> PHONE(1): 2096032045 PHONE(2): FAX OR E-MAIL: fongchea@me.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact yo ar a anpo nt a date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE 3-30.2018 <br /> I. List up to ten addresses ipffi6space below. Address ranges VWLL NOT be accepted. Select the type(s)of files from the <br /> list below by checking 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 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 END 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$182 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: ust install plans <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 /> ❑X Underground Tank(UST) street# Street Name City <br /> Cleanup Site(LOP) 17 CONSUMER <br /> ❑Other Cleanup Site(Non-LOP) ' 2512 waterloo rd stockton <br /> ❑Hazardous Waste <br /> p DAIRY <br /> ❑Tiered Permitted Facility 2 <br /> ❑Aboveground Tank <br /> ❑UST (Monitoring/Removal) ❑PWS <br /> ❑Hazardous Materials 3 <br /> ❑Spill/Release Response <br /> ❑ <br /> Solid Waste Facility/Vehicle [3 WATER QUALITY <br /> ®Food Facility <br /> ❑Pod f Spa ❑SITE MmMnON <br /> Dairy 5 <br /> ❑Land Use Applicetbn Sites I , <br /> ❑Septic Pumper Truck/ a E J ij dV feu/I ❑Housm <br /> Yard/Chemical Toilets �W <br /> ❑Wastewater Treatment Plant ❑CUPA <br /> Housing Abatement i ASTIHMfHW <br /> ❑Mote'%tel <br /> ❑Chk:ken Ranch I Dog Kennel ❑CUPA <br /> ❑Medical Waste Facility a LIST <br /> ❑ <br /> Tattoo/Body Piercing <br /> ❑Waste Tire 8 [3 SOLID WASTE <br /> ❑Complaint <br /> ❑Other(Please Specify): ❑AccourmxO <br /> to <br /> '"*BOXED AREA-EHD USE ONL1N't <br /> ac' , <br /> IX <br /> Records Erovided by Staff-PPR Complete.staff Name. ' c l 1 EHo 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 />