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Feb, 15. 2013 10:49PM Geocon No. 0730 P. 1 <br />r DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />FEB 1 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />0fVPj"i0N 1,E1 fiJ-r EALTl-t PUBLIC RECORDS RELEASE�APPLICATION <br />taG �I.r,i � lhFl #VIi,�S <br />APPLICANT: y�tM) '�T,([��C,(/� BUSINESS/AGENCY: �t�,►1S�1, <br />ADDRESS: lf(eo Goldlt-a_tLg� b+,\re_ nuc% X10 CITY/STATE/ZIP: g gs JD ; S7YZ <br />PHONE (1): ( 5L- (( PHONE (2): FACSIMILE: / - -Y132- <br />TENTATIVt5' APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITEREQ EST - 3125 EEE (CASH OR CHECK O LY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT � � DATE Z`15 -12d! 3 <br />Electronic Information: ❑-List ❑ Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />Street p Street Name City Unit 1 <br />, t- i /u k <br />�Ya 7l�(�� 'moi f',r t . 1A ' 1 0 Unit 2 <br />2. <br />3. <br />' unit 3 <br />4. <br />! iv , Unit 4 <br />6. <br />21 <br />7. <br />$,/ <br />7(,0 <br />(� F 11 ° Ai f�f Ij Unit 6 <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested; From /// /1 -cm -o to 2 /7 ZD/ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />[^t]'G�NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACIIrITYNE ICLE <br />U1 HIR CLEANUP SITE (NON -LOP) ❑ HOUSINO ABATEMENT ❑ WASTE TIRE I � fi 1e5 �V <br />DERGROUND TANK (MONITORINGIREMOVAL)-/-�= n Fnnn Fern ITY I-1 DAIRY K.0 3-I -1 _Z';' <br />�OVEGROUND TANK —` .-ry,� {fl i l Oma, �►g c e��? p�r�r �tscvre n j+W 7.)e '4' <br />FIAZARDOUS WASTEMAZARDOUS MATERIAL5L 10ZI ���� ���^7�j(�r� aq �f I �i 3 c��� U 5, 35 C)q(o) <br />❑ TIERED PERMITTED FACILITY <br />F1 TATTO0IBODY PIERCING 3 I y�. 3 a� a5, 3 Y q09 , d- ES 0 -2 K{3 <br />WELL AND SEPTIC PERMIT RECORDS ATZE AVAIL°(:V/'Ilit"- ��r �►n`nUv'�sof 11 15 <br />1. List up to ten_addresses in the space above.�� c3c� <br />box(es). At least one file type MUST be selet <br />ranges will not be accepted - for additional a a <br />3:00 pm will be processed the next business For -?04 zc h.lr <br />2. The EHD will notify tho applicant if any EHD files exist. An appointment for revic <br />days after receipt of application. The files will be held for a maximum of five but <br />should be scheduled accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately avail <br />submitted when the file is available. <br />view the HMMP (Hazardous <br />Materials Management Plan) go to the <br />following website:,www.sjoesdata.org '' <br />a <br />4. Any file not returned in the same oonditlon as released will be reorganized by ENu spall aa uNc CAVVI m ui uo aNr^��•r <br />Future rile reviews by a same applicant may require a$ 126 deposit prior to review. '* B CLp ARi A^z;>=HD USE C�:MiY <br />• ;_.�::,i h':M.:•. ::=J%J.: in '• `} I:f`i9: ew <br />414':1'' 41.i;ep�71`��r:;?�I, r` <br />D ,RecO;rcls`ptavl.ded by Staff-P:,'P oi.0.01 e.:siaffNain@ <br />1a•�i►fei�rtyA�s�c19 IP <br />Received Time Feb. 15. 2013 10:47AM No. 2 N"i3` <uv'.df�G Gi/7GvuLI <br />tj 110 �r-flo-l" I01u -kfli li ; yfl zep/14 C-A3a'/ <br />