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05/28/2013 06:38 FAX 0001/001 <br />�■ ' €� �� S O EHD LOG NUMBER <br />AN .J AQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />MAY 2 8 2,013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENLKRONMENTAI. REALTH <br />PERMITiuERVlCE, PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �jta, T r Anz BUSINESS/AGENCY: RP -T -0L -e C;tIU�C/6c( <br />ADDRESS;((�% ,� try !fr?A .97--1 CITY/STATEIZIP: ,4r��v'/� 9S?•0 3 <br />PHONE (1):PHONE (2): FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE: ,/-3 Tlme: <br />(Please allow 10 business days from data of gppllcation submittal-'Tentetiva only - must be contlrm*d) <br />❑ CHECK BOX TO EXPEDITE REQUE $125 FEE ( C ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE r J 2--7 13 <br />Electronic Information: ❑ List ❑ Map - De crlption: <br />II <br />FILE ADDRESS <br />EHD USE ONLY <br />City <br />— _ <br />UnIt2 <br />To view the H M M P (Hazardous <br />_ Materials Management Plan) please �ita <br />go to the following website: <br />www.sjmap.org/hazmatviewer/viewer.asp <br />�lJnit 4 <br />ualt s <br />' <br />Stmt 4 <br />�Q <br />Stra*t Nam* <br />Vv nT V�' <br />2' <br />3 <br />4. <br />g, <br />6 <br />_ <br />7. <br />n rMit R <br />10. <br />Specific Data Ring* of Information Requested: From / to I/ /Zc* <br />ENVIRONMENTAL REAILTH DEPARTMENT FILES <br />Q fIDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLEbj7 3 <br />�QER CLEANUP SITE (NON -LOP) ❑ HOUsiw ABATT:MENT ❑ WASTE TIRE <br />ERGROUNDTANK(MONITORINGMEMOVAL)�. ❑ FOOD FACILITY El DAIRY <br />VEGROUNn TANK � ❑ CHICKEN RANCHI DOG KENNEL [:]WASTEWATER TREATMENT PLANT <br />DOUS WASTEMAZARDOUS MATERIALS, ❑ MOTELIHOTEL Q PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE 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 (209149"i3B or mail to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with Elle 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 some condition as released will be reorganized by EHD staff atthe expense of the applicant. <br />Future file ruviews by the same applicant may require a $126 deposit prior to review. —BOXED AREA - EHD USE ONLY <br />r �) <br />V,- - <br />?. r,' ., , , L rr / r 1r I <br />0 Records provided by Staff -PPR Complete. Staff Name: <br />H[34 _N <br />Received Time May. 28, 2013 6:38AM No.3196 <br />;Alii <br />l <br />