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DATE RECEIVED EHD LOG NUMBER <br /> ( <br /> SAN JOAQUIN COUNTY <br /> , C. '_` E ��b ENVIRONMENTAL HEALTH DEPARTME14T <br /> (LlN' u��y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 T31q � <br /> jUN201Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> V PUBLIC RECORDS RELEASE APPLICATION <br /> 'Ego ( G✓vj+ Gl0'Vi BUSINESS/AGENCY: (\'A � F I< �n , l <br /> 0 ESS: m113CITY/STATE/ZIP: <br /> PH0NE (ii4`1 :it" PHONE(2):_ FAXORE-MAIL:(alc�i <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 EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG14ATURE OF APPLICANT DATE <br /> 1. List up 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. Far,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 cond'don 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$130 deposit prior to review. <br /> Vk(ELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AIJ-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL I Co uAl I . 6_ <br /> HEALTH DEPARTMENT FILE ADDRESS ��� ��� ����P <br /> FILES <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) �( ❑CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) <br /> HAPAROOUS WASTE LI Dvav <br /> � '�a TIERED PERMITTED FACILITY Z /{�ri� L1Ve ou�t� N0 �N0 s <br /> ABOVEGROUND TANK �1 7 <br /> Fl LIST (MON70FJHG/REMOVAL) EDPWS <br /> [.�HAZARDOUS MAI EHIALE p olll/ I / '/ • / I�� <br /> SPIWtV <br /> RELEASE RESPONSE 1 I L {, <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 41 p <br /> ❑FOOD FAOIUTv I� �l VL Ozk <br /> ❑POOL SPA <br /> SIM MITIGATION <br /> V <br /> DAIRY 6 �O�l o� I:((0 oz/{" <br /> ✓f�,." l 1 , NO c015 <br /> LAND USE APPLICATION SITES L W `y <br /> SEPTIC PUMPER TRUCK/ //�, 1 a,n /,�T(/)I/�� /� /� ❑HOL'il::.. <br /> A,.., YARD/CHEMICAL TDILETS S L�Ive, O� S�VI l✓• 1 �" , ��� ..f� <br /> I N WASTEWATER TREATMENT PLANT rr_ CUPA <br /> Y❑-'HOUSING ABATEMENT T l01 6� �. e, oa r <br /> ❑MOTEUHOTEL { ` VC/ �\ <br /> ❑CHICKEN RANCH/DOG KENNEL jSdCUPA-HAZ-MAT <br /> MEDICAL WASTE FACILITY <br /> loWP3 Y �g Spok No d1l. No WAaM60 <br /> TATTOO/BODY PIERCING ��� SOLID WASTE <br /> WASTE TIRE NO jb �Q <br /> IY L C`7 lVY^ I v I <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): WWI In5 ❑AODOUNTING <br /> L "'BOXED AREAEHDUSE ONLY"' <br /> I <br /> ❑ Records provided by Staff-PPR Complete. Start Nam.: <br /> EHD 46-06 <br />