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1 E <br />DATE RECEIVED EHD LOG NUMBERSAN J AQIN NTY <br />ff ENVIRONMENTAL HEALTH DEPARTMENT <br />Vepphone: <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />qlqlfl <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: I "It & <br />BUSINESS/AGENCY: <br />ADDRESS: W-16rox c-& CITYISTATE/ZIP: W44111q, _l <br />PHONE (1): -550—L/ 45-7— PHONE (2): -13O -- V, 3 FACSIMILE: 15-30—C33 —O) 0 <br />TENTATIVE* APPOINTMENT DATE: A5 /p,14 6/e Time: <br />(Please allow 10 business days from date of application submi I -*Tentative only - must be confirmed) <br />(Ze>j CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />I0\ <br />SIGNATURE OF APPLICANT ?(�k,h�� l �l�i'� — (_ <✓I {�, �I w �l DATE <br />Electronic Information: ❑ List ] Map — Description: <br />%UC <br />FILE ADDRESSEHD <br />USE ONLY <br />CP - ] Unit 1 <br />Street # Street Name <br />City <br />1. <br />L I Wr <br />�, <br />2. <br />U, fZM C�� r .- <br />c_ <br />3. <br />c <br />Unit 3 <br />4. <br />) <br />�—�t <br />5. <br />y <br />�,❑ unit <br />6. <br />� <br />7. <br />t �!' F <br />\ <br />To view the HMMP (Hazardous ❑unit s <br />Materials Management Plan) go to the <br />following website: www.sjoesdata.org <br />Unit 6 <br />g <br />k.;. r ;.: <br />9 <br />10.cX] <br />Specific Date Range of information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ESOLID WASTE FACIL IVEHIC ,E <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT �ASTE TIRE I f J� ��%r <br />UNDERGROUND TANK (MONITORINGIREMOVALV- ❑ FOOD FACILITY ❑ DAIRY ' i - Cj 3 <br />ABOVEGROUND TwDk_ ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLAN <br />[KHAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />LJMIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING CRCOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. 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 />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <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 $125 deposit prior to review. -BOXED AREA - EHD USE ONLY <br />P .A % '2' 0r(). <br />%UC <br />/r <br />AR <br />r <br />Records provided by Staff -PPR Complete. staff Name: , <br />vdij.-Aw <br />EHD 48-06 T 1 �ftifij�l.©��i.G�)'I i "A " "' �lL60M N 2!1 �t`JC.�TfZ�/ �� (.X/V"'� �/(o ,55; Z_ c� � <br />00`7 017, <br />u' <br />i <br />