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'.■ROM : JODI VANNEMAN <br />I■ <br />r■ <br />1 r -r.- ," <br />DATE r EC(i±FVE <br />t� <br />FAX NO. : 4154793988 <br />SAN JOAQUIN COUNTY <br />Feb. 25 2013 09:22AM P1 4; <br />FEB 2 5 2013 ENVIRONMENTAL, HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-8232 <br />Te!€ Dolle: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EI��f�`' �� S� <br />I�Y <br />PUBLIC RECORDS RELEASE APPLICATION <br />FHD I,OG NUMP,FR <br />APPLICANT: Jn ( Ua n nl?mg.n BUSINESS/AGENCY: 4ni&r 6S <br />ADDRESS: �� ClG CITY/STATE/ZIP:a. <br />PHONE (1): !�^ PHONE (2) _y%��' ��f� FACSIMILE: <br />TE ATIVE"APPOINTME T DATE: T•Time: <br />(Please allow 10 business days from date of application submittal-'renWfve only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST -$125 FEE (CASH OR CHECK ON LY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />R" 6THER CLEANUP SITE (NON -LOP) <br />Street # <br />_ <br />Street Name <br />City <br />1: <br />2.Tc, <br />wrap <br />, " r <br />�. <br />i - 1A 4 <br />'1 <br />� , <br />'� Unit 2 <br />3. <br />MEDICAL WASTE FACILITY <br />COMPLAINT RECORDS <br />j Unit 3 <br />4. <br />El -Unit 4 <br />To view the HMMP (Hazardous <br />Materials Management Plan) go to the <br />following website: www.sjoesdata.org Units <br />❑ Unit 6 <br />6• <br />- <br />7. <br />13 <br />9. <br />— <br />- <br />10. <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL <br />a-11NDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />HEALTH DEPARTMENT FILES <br />❑ HOUSING, ABATEMENT <br />R" 6THER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />'LINDERGROUNDTANK (MONITORINGIREMOVAL)X <br />❑DOGKENNEL <br />;]-KA7ARDOUS WASTE GENERATOR( <br />❑ CHICKEN RANCH <br />TIERED PERMITTED FACILITY <br />L._I MDTEIJHOTEL <br />TATTODI$ODY PIERCING <br />Q POOLISPA <br />MEDICAL WASTE FACILITY <br />COMPLAINT RECORDS <br />to <br />❑ SOLID WASTE FACILITVIVEHICLE <br />❑ WASTE TIRE J J[[��'' e5 A, bAl <br />❑ DAIRY �'6 �j y �j <br />n WASTEWATER TREATMENT DANT" <br />❑ PUMPER TRUCKMARDICHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />E] 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 o1• 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. <br />Re'ce'ived Time Feb. 25. 2013 8:20AM No. 2388 <br />