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12/12/2012 12:39 5106559517 ENVIRON FAVI nl�ni <br /> EHD LOG NUMBER' <br /> ° +����� � SAN JOAQUIN COUNTY ,�, � `� <br /> v1= ENVIRONMENTAL HEALTH DEPARTMENT `A <br /> DEC 12 2012T 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTACHEAIT <br /> PERMIT/SERVECESH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: > } K0.3r2, Lo O_n BUSINESS/AGENCY: PNVtf2AN <br /> ADDRESS: a,r.1-00 IFbVyE.\\ St-yEiL-\-i $y_�A4 app CITY/STATE/ZIP: Eyyl"I\2, GA -14(aPS <br /> PHONE(* $10— L4p0-XR(02 PHONE(2): IrOS) -308 —I FACSIMILE: Sl0—(nSS'=lSl� <br /> TENTATIVE"APPOINTMENT DATE: e7yAte con•ktcf*sckAdtdf Time: <br /> (Please allow 10 business days from ate of application submittal-•Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST $125 FEE ICASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ ap—De ription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ff Street Name City U <br /> 1. po 5, gecluma.tn PLCA /.Dc!i U�7 194 i r IU <br /> L 2. <br /> ❑Unit <br /> 3. <br /> 4. <br /> Unit 3 <br /> 6. _ - ❑.UnIt4 J <br /> 5 z(J#T' To view the HMMP-[Hazardous <br /> 8. Materials Management Plan)go to the ❑Unit <br /> 9. following website:www.sjoesdata.orp,A <br /> 10. El Unit 6 1 <br /> Specific Date Range of Information Requested: From /.& cYa k j to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUrYNEHI <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT �fiIe� l '^"•I <br /> UNDERGROUND TANK MONITORINGIREMOVAL�' ❑WASTE TIRE <br /> ( ) FOOD FACILITY ❑DAIRY � (Z-W-4 Z <br /> ABOVEGROUND TANK V ❑CHICKEN RANCHI DOG KENNEL EIWASTEwATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALSp)^ ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMK:AL TOILETS <br /> TIERED PERMITTED FACILITY (Xj ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOI8oDY PIERCING yY�g'f COMPLAINTIRESPONSE 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(2091464-0138 or mail to.the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. 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 END 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 END staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. •�°�'""' 'Fc <br /> (2 (7' Pie <br /> j� us <br /> Received T'irnDec. 12• 202F11 43ANo�18 mE; — - <br /> E.._ .___ 914112 <br />