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�� rr Auo. 11 2016 11 :45AM No, 2941 P. 1 <br /> 121L Eciv B `�ul SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ra HAS <br /> ENVIRONMENTAL HEALTH DEPARTMENT � � ��� e'� �. <br /> AUG I HAS 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> IfZr C I 'E ST C°fes` FH:, PUBLIC RECORDS RELEASE APPLICATION <br /> APPLlCANT: ASI rm ,01-MiS_ SUSINESS(AGEHCY: SU_ CDVXT ( PV412116- LQ)17!S <br /> ADDRESS: MtiI-'_M iii- CITY15TATE01':JSIT(;SG' c4i_ <br /> PHONE(1): 'ZCU— 3(ne' PHONE(2): FAXORE-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be avallabie, <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> I CHECK BOX TO <br /> $H OR CHECK 2ML1 <br /> EQ <br /> ATE <br /> 11V!=[s ttllp.t0`.en addrRE OF lesses i7nthe Dspace below. Select the type(s)of files from thedist below by CANT <br /> D checkiB tel/Iappropria <br /> fe <br /> box(es). At least one file type BUST be selected. Fax to (209)464.0130 or Miall UJ 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 Eke applicant. <br /> Future file reviews by the same applicant may requlre a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FP.IDAY a:00 AM-5:001"Mi(EXCLUDING HOLIDAYS) <br /> Elecironicinformation: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> f4,E4LTHDLESRTmEhT FILE ADDRESS EHD USE ©N1..Y <br /> _ffUN-EE--ROUND TANK(UST) Street# Street Name city <br /> CLEANUP 9rtE(LOP) <br /> BOTHER CLEANUP SITE(NON-LOP) I J VV L'✓�I l�i I J I i •GC/1 �I ✓YI✓' ) i <br /> EV7 HA?ARDOUE VJAETE <br /> r� 0 / DORY <br /> TIERED PERMIITY TTED rACIL2 ✓�v3JG W�vlln� 3�W� Wr)l VI�r�/i,+rf.,, I <br /> E2/ABOVEEGRONND7ANK ✓ 1 / �� y/�/ y� /�1y1Iy1 (/�' ,/�//�" .J\✓ /�////� C I <br /> [—/.j HAZARDOUS MATERW.B oV�') �Pws <br /> L <br /> �1 'SPILVREIEAsa RESPONSE ' <br /> 21'50LID WA$M FACILITY/VEHICLE WATER Ou.�Itt <br /> P <br /> E f rOOD r.CILITY <br /> �PODL/SPA SITE MTBATION <br /> DAIRY e <br /> BLAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK l 9 HO elnf <br /> 6 <br /> YARD/CHEMICAL TOILETS ' <br /> ©1NASTEWATER TRFkTW.SKT PIANT <br /> �HODSING AEATEMENT GUPA <br /> ❑MOTEVHOTEL <br /> [/cH OKEN RINCH/DOG KENNEL UST <br /> ❑MEDICy,WPS-FACILITY E <br /> TATroo aODY PIERCING <br /> ✓WASTE TIRE eJLIe W4'iG <br /> Zl_�oMPV.INT <br /> .❑OTHER(PLEA+E EPECIF+): <br /> A�CJYMiNJ . <br /> TD <br /> ^aOXED AREA•END USE ONLY' <br /> I] Records provided by Staff-PPR Complete. ruff N... <br /> Received lime Auo, 11. 2016 11 : 38AM No: 1089 <br />