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v. <br />DATE RECEIVED <br />AUG <br />E.,ArIROKitViEgt-AL HEALTH <br />PERT4n7F-:,,ERVICES <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazeiton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />APPLICANT: Li rt. co/si '?ro e5 BUSINESS/AGENCY: <br />ADDRESS: /SS-5cl 6b0 CITY/STATE/ZIP: Z.os 6.471D s C: 4 9S 3 <br />PHONE (1): (1.16y0 390 —c--(737 PHONE (2): 4c)<6.,) 9(4 7 z FAX OR E-MAIL: hilcd,-Ipru ji,-Aevii.e.,:s. WS-- <br />Please allow 10 business days from date ° application submittal for the records to be available. e (awl <br />Staff will contact you to arrange an appointmentMte and time to review the requested records. <br />El CHECK BOX TO EXPEDITE REQU„EST:T3)39 FEE (CAB/H2OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT J. ef.Ate DATE <br />List up to ten addresses in the space ow. Select th type s) of flies from the list below by checkln the appropriate <br />box(es). At least one file type MU e 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 />For assistance In identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />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 />Any file not returned in the same condition as released Mil be reorganized by El-ID 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: Li List 0 Map — Description: <br />Specific Date Range of Information Requested: From <br /> <br />2_o c;i0 to 2_oe <br /> <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FILE ADDRESS EHD USE ONLY <br />I fiatgDERGROUND TANK (UST) <br />1 CLEANUP SITE (LOP) <br />HER CLEANUP S 215 ITE (NON-LOP) <br />ZARDOUS WASTE <br />EliTERED PERMITTED FACILITY <br />ErrBOVEGROUND TANK <br />ST (MONITORING / REMOVAL) <br />AZARDOUS MATERIALS <br />Street # Street Name City , <br />1 7& ,,, 5-- 0 <br />4.K.1110/V r a‘ "SrOCk. Z4/ <br />li CONSUMER <br />'e-- <br />2 <br />0 MI IV 0 DAIRY <br />,_- <br />3 <br />'L/RELEASE RESPONSE <br />V <br />0 PWS <br />4 <br />le WATER QUALITY <br />/ <br />111 SOLID WASTE FACILITY / VEHICLE <br />111 FOOD FACILITY <br />P•rbOL / SPA i.e <br />5 <br />RS SITE MITIGATION <br />' 1111 DAIRY <br />, KI•D USE APPLICATION SITES <br />0 SEPTIC PUMPER TRUCK / <br />YARD / CHEMICAL TOILETS <br />II WASTEWATER TREATMENT PLANT <br />ci <br />EiHOusiND <br />7 <br />(iCUPA <br />-USING ABATEMENT <br />0 MOTEL/HOTEL <br />II CHICKEN RANCH I DOG KENNEL <br />a <br />1CUPA - UST <br />D MEDICAL WASTE FACILITY <br />. TATTOO/BODY PIERCING <br />9 <br />0 SOLO WASTE NI WASTE TIRE <br />12•CTITPLAINT <br />gen<R(PLEASE SPECIFY); i .. , • <br />kiciaVr's Z-1-?-4-Ls <br />lo <br />0 ACCOUNTING <br />"'BOXED AREA- EHD USE ONLY*" <br />0 Records provided by Staff-PPR Complete. Staff Name: <br />F1-111 AR-GS