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Cc 11 12 06:01p Lee & Pierce, Inc. 2098488274 p.1 <br /> ATE I"«ciV ff D EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue Stockton CA <br /> 95205-6232 <br /> DSC Ifiephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ' LJ PUBLIC RECORDS RELEASE APPLICATION <br /> �����{{��rt I r +i hh <br /> APPLIC�MT: �jo . �. LO e , BUSINESSIAGENCY: Lee 1 �fke.Y 'c 11/,4 <br /> ADDRESS: ��� S, �us� �ve Sc.{�2 /41 CITYISTATE/ZIP: C I�GG 1�2 Ci (It <br /> PHONE (1): 2.0 1 Sl b &170 PHONE (2): � qA 5 12 FACSIMILE: 2e cl `1at��5 7 <br /> TENTATIVE*APPOINTMENT DATE: 5A > Time: <br /> (Please allow 10 business days from dale of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS ES DAYS <br /> SIGNATURE OF APPLICANT DATE �2 1 1 2— <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> �cC-�f �o __f-�vU <br /> 2- S33 }'� t—�✓1�R Q V� 5�0 ❑/ Unit 2 <br /> 3. 1 - <br /> 4. H L4 L � C O" �Unit3 /y <br /> 6. ��(157 �i Clu'S e �= /v .F. ` (S� ID Unit <br /> 8. �20 El Unit 5 <br /> 9. <br /> ©- To view the HMMP(Hazardous El Unit s <br /> Specific Date Range of information Requested: From Materials Management Plan)go to the <br /> ENVIRONMENTAL HEALTH DEPT following website:www.sjoesdata.org <br /> IA13OVEGRouNi) <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FAC :HICLE f r <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT <br /> NDERGROUND TANK(MONITORINGIREMOVAL)� ❑FOOD FACILITY DAIRY <br /> TANK ©t ❑CHICKEN RANCHI DOG KENNEL (1(ASTEWATERTREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALSvZ. E]MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> IERED PERMITTED FACILITY D(- OOLfSPA ❑LAND USE APPLICATION SITES <br /> ATro01BODY PIERCING COMPLAINTIRESPDNSE 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 US ONLY <br /> Z-Z o " l moi' <br /> � r <br /> i -Z ' Prov; o x - 0 7G <br /> Received Time Dec. 11, 201'2 5:02PM No. 835 <br />