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.d'f�' ;c SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 18 2016 ENVIRONMENTAL HEALTH DEPARTMENT 815100 <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> ENVIROMAENTAL HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> • PERMITISERMUES PUBLIC RECORDS RELEASE APPLICATION O'n <br /> APPLICANT: }. ' 2.. BUSINESS/AGENCY: r-Cu o f C I ill <br /> ADDRESS: 0 (< CITY/STATEfZIP: p V 0 <br /> PHONE(1): L11 JPHONE(2): FAX OR E-MAIL:t.9j 6L <br /> C- <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 EX/ TE REQUES -S FOE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3BUSINF. S DAYS <br /> SIGNATURE OF APPLICAI+{If DATE �LTj <br /> 1. List up to ten address-§In the space be elect he typ ( f files from the list below by chec I the appropriate <br /> box(es). At least one file type MUST be sWacted. Fax to(209k464-0138 or mall 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 REC RDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic Information: Eq List ap—Description: iTV4 E77 1" <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES _ EHD USE ONLY <br /> uDERGAouPO TANK(UST) street# Street Name City <br /> ��//CLEANUPSTre(LOP) �7� vL �C=NSNYEa <br /> • I/IOTI}ERCLEANuPSuE(NON-LOP) T U4'II�� 12�� <br /> ,,(�,,,������,V�`��`'/AURDOUR WASTE N A la�/L Cl CAIN, <br /> �REORERMITTA FaaLEfY Z <br /> ���-��-��/��/BWEGRDUNO TANK <br /> T (MONITORING I REMOYALI El PWS <br /> H RU'D MATERIALS S <br /> $Pltt/RELEASE RESPONSE <br /> dSGUD WASTE FACILITY/VEHICLE �1` 1111 ,il..,/4n WATER Ouuflx <br /> ❑FOOD FAcuNY <br /> S�1b0 F1y]f <br /> POOL/SPA y/� IrL�(1 ��//�J/�y,���y�� SRE MrtIGATICH <br /> ❑ AIRY S gg21 ' TL• {LI a II/• , <br /> �U USE APPLICATION SITES <br /> EPTIC PUMPER TRUCK/ 13 MOULH(1 <br /> WARO/CHEMICAL TOILETS r <br /> ASTEWATER TREATMENT PLANT <br /> CUPA <br /> HOUSING ABATEMENT T <br /> MDTELMOTEL I I <br /> ❑CHICKEN RANCH/DCG KENNEL III PA-UST <br /> ❑MEDICAL WASTE FACILITY , r <br /> TATTOO/aODY PIERCING <br /> n WASTE TIRE GOtIO WwSTE <br /> 9 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIR') A.LNHNG <br /> 10 <br /> -BOXED AREA.EHD USE ONLY- <br /> 0 Records provided by Staff-PPR Complete. St.ff Nain : <br /> END 4MG <br />