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05 2013 11:40AM Sage 9724809865 page 1 <br /> - <br /> f7 0{ � IVj EHD LOG NUMBER <br /> LA SAN JOAQUIN COUNTY (� <br /> APR 0 201 <br /> ENV/ ONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)4.08-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd \1 <br /> ENVIFIONMEffrAL HIr 41 TH <br /> PERit,IPSERVICES <br /> PUBLIiCI RECORDS RELEASE APPLICATION <br /> APPLICANT: I L BUSINESSIAGENCY: '51jl"r <br /> ADDRESS: t 1Qq`�} ,¢, O-k,3 �10 CITY/STATE2IP: �l��tu 3c�� ��Qt�t1� C75-CM0 <br /> PHONE(i): q�,� bf)' / PHONE (2): 0 79-8 FACSIMILE: y7or SLAV 6(��y9�" <br /> TENTATIVE`APPOINTMENT DATE: t•f-1 - Time: <br /> (Please allow 10 business diIjvs from date of application submittal-'TentaoYe only-must be condi ed) <br /> ®CHECK BOX TO EXPEDITE REQUES')'-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �/�,S'- &20/ ? <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City LD 1 <br /> 1. 3 0 O �OWtvi 4�ecKZZ <br /> � Unit Z <br /> f� 3• n �swdtnt(/YS <br /> 'C 4. 4I� <br /> � 14 0c, J 17-1 Unit 3 <br /> 6• AY A <br /> 14 �l 1 <br /> f3. <br /> To view the HMMP(Hazardous <br /> T Q aterials Management Plan) please. <br /> 8• go to the following website: <br /> 9• w.sjmap.org/hazmatviewer/viewer.a <br /> 10- L <br /> ,O-u�tt e <br /> Specific Date Range of Information Requested:—Frdm. '� to / <br /> 1 %.&;, EN%A ONMvENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(COP) ❑MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYNEHICLE 22. <br /> ®OTHER CLEANUP.SIT F.(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY j- <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATME <br /> HAZARDOUS WASTEHAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUt1PER TRUCI(IYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA <br /> ❑TATTOOIBODY PIERCING ®LAND USE APPLICATION SITES <br /> 13 COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AYAI LABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PNI(EXCLUDING HOLIDAYS) <br /> 1. List unto ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). Al least one file type MUST beeeleeted. 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 ErHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The fila5 will be held for a maximum of five business days for review. Appolntments <br /> should be scheduled accordingly. - <br /> 3. A file that Is actively being worked on byLEHD 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 e reviews by the same applicant mayrequire 5 deposit prior to review. '• c�lic="' R <br /> 'rirt <br /> 4, I <br /> it <br /> e <br /> b <br /> Received Time Apr. 5. =2013 9 41AM No. 2751 y `�-13 �lelnetuc. III' i ' b�j�4LVI he �K <br />