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EHD LOG NUMBER <br />DATE RECEIVED SAN JOAQ IN v NTY <br />q _ <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />I '� '� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />l`e ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ql <br />a Q PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: OWI BUSINESSIAGENCY: Zot, <br />4 <br />ADDRESS: j b �% g/ jL'& CITY/STATE/ZIP: Wkt,14,4 <br />PHONE (1): 50– L/4,5_7 PHONE (2): -130 S, FACSIMILE: <br />TEN TATIVE*APPOINTMENT DATE: /}g Sart s ,r,/,yifa i6l,_� Time: <br />(; J / (Please allow 10 business days from date of application submi I -'Tentative only - must be confirmed) <br />(2CJ ` CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQ)IEST PROCESSED IN 3 BUSINESS DAYS <br />JIB <br />SIGNATURE OF APPLICANT:fL-1, t;4\k -7, DATE <br />Electronic information: <br />❑ List ❑ Map – Description: <br />FILE ADDRESSFSHD <br />USE ONLY <br />cp <br />Unit 1 <br />Street # Street Name City <br />1. <br />qj <br />ftr Ujq, <br />G IMA <br />7 <br />- 2 <br />2. <br />(�: RMca", , - <br />3. <br />da22 Ali ot <br />0k <br />Unit 3 <br />4. <br />f <br />5. <br />1 <br />r <br />;,❑ Unit 4 <br />6. <br />7. <br />R Pk <br />,` �:: <br />To view the HMMP (Hazardous <br />Materials Management Plan) go to the <br />following website: www.sjoesdata.org <br />❑ Unit <br />e <br />Kt] Unit 6 <br />g <br />9 <br />10. <br />Specific Date Range of Information Requested: From - <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACIL NE`HICLr J, f "? <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT OWASTETIRE li ;" i'� �� I( <br />UNDERGROUND TANK (MONITORINGIREMOVALV_�- ElFOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANFf�_ ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLAT <br />[KHAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />Q.TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING RCOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (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 />END 48-06 <br />Tq A 1rt n07 LtrIvMl <br />i t It Iil'iT' �i�f 2 ,rirra..•t LL. ii = r:L–�ti� i� �i� i r <br />END 48-06 <br />Tq A 1rt n07 LtrIvMl <br />