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Y I <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQ IN NTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> / �JeVeppthone: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 lot <br /> 6� (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> {� <br /> a QQ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D"It &e_ BUSINESS/AGENCY: 'r/e'f r':S� <br /> ADDRESS: 1 b�j gebac-Alz CITY/STATE/ZIP: W4t-1flq� f3 �°L <br /> PHONE(1). �0-L/45- t6g,)j PHONE(2): 5a3d q�3- W 5-11 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: A5 Sorg as atly14 d/c Time: <br /> (� (Please allow 10 business days from date of application submi I-*Tentative only-must be confirmed) <br /> tCHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQPEST PROCESSED IN 3 BUSINESS DAYS <br /> ,I SIGNATURE OF APPLICANT-(,{ 6h\jt ft�j'- (.L6( Vl w �r DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS FSHD USE ONLY <br /> Street# Street Name City �J 6t]Unit 1 <br /> 1- qCkffk <br /> 2. U I`LN! Gcu <br /> 3. v G,�/7l r��16Z A: i-�SJm}�j I <br /> 4. P �`l Unit 3 + <br /> 5. sao <br /> r 1 ) <br /> 6. <br /> ❑unit <br /> 7. <br /> g a ti ;` `;;:: To view the HMMP(Hazardous ❑Unit s <br /> 9 Materials Management Plan) go to the <br /> 10. following website:www.sjoesdata.org 0 <br /> ,L7 Unit s <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 . IVEHICLE �f <br /> OTHER CLEANUP SITE(NON-LOP) <br /> El ABATEMENT ASTE TIRE �j �1,5; <br /> UNDERGROUND TANK(MON rrORINGIREMOVAL) ❑FOOD FACILITY []DAIRY ris <br /> ABOVEGROUND TANV_ ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLA <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOMODY PIERCING �RCOMPLAINTIRESPONSE 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 re iews by the same applicant may require a$125 deposit prior to review. -BOXED AREA-EHD USE ONLY <br /> 4P AAk1j1 17 KI 1p,i <br /> )Mktt-dA <br /> 1U N1 lP t <br /> Records pr�onvided by Staff-PPR Complete Staff Name: ' <br /> EHD 48-08 T'Wfflai,11 COMP <br /> GU CID ;55 j G qoq, w P-7T 98WZ11441, L0002;-01 d&.1337, <br /> W0077507 , <br />