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01/22/2013 10:48 9254260106 BUREAU VERITAS PAGE 01 <br /> "Oct EHD LOG NUMBER <br /> oATERECEIv� SAN JOAQUIN COUNTY <br /> �C3 ENVIRONMENTAL HEALTH DEPARTMENT 0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 0 <br /> >P phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd ���/// <br /> �sJ�a /PUBLIC RECORDS RELEASE APPLICATION / <br /> APPLICANT: j4j, ,, {i6SINESWAGENCY: ,f31 ,KLA✓riR-S �jy � <br /> _ ADDRESS: ZAla) Tae• -t•o hlalmnq CITYISTAT6/ZIP: 5;�j e,; il , <br /> PHONE(1): o6)�qn_6 -3o PHONE (2):l Dz2-57 3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentavve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$ <br /> ,PS_FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List L Map-Descrip Ion: <br /> FILE ADDRESS EHD USE ONLY <br /> O� street# Street Name city 0 Unit 1 <br /> 1. I rYZtC i <br /> 2. - �- 17UnIt2 I. <br /> 1" 3. c7�JU s ' i hco ; 5l Nmm <br /> 4 Unit 3 <br /> 5. <br /> 5 �❑Unit 4 <br /> 6 To view the HMMP(Hazardous <br /> A B Materials Management Plan)go to the ❑ Unit 5 <br /> following website:www.sjoesdata.org <br /> 9. <br /> 10. 10s Unite <br /> aAll <br /> Specific Data Range of Inforrnatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ts 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTEFACIUTYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTETIRE 5v-IP5 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUNDTANK ❑CHICKEN RANCHJ DOG KENNEL WASTEWATER TREATMENT-"PLANT <br /> Q HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYAROICHEMICAL TOILETS <br /> k, TIERED PERMITTED FACILITY ❑POOUSPA Q LAND USE APPLICATION SITES <br /> fl ❑TArroolSODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> 3- WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 <br /> AM <br /> WELL (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 12091484 0138 or mall to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications recelvael after <br /> V\ 3:00 pm will be processed the next business day. <br /> 0 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> ti 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 retumed in the same condition as released will be reorganized by EHD staff at the ex 3ense of the applicant <br /> p Future fila reviews by the same applicant may require a$125 deposit prior to review. ,J;�I <br /> ; I N q i is 11 <br /> Miami <br /> rilal. , I g <br /> )' �. <br /> EHp neon 'a o-f t1),{t 1¢. L (� <br /> a•y 13 �/I fV1��'�`j�) re nc� -rye j��lclu��ixj f�111f��u <br /> c igged(I'Vii : LL. (fl ) D 2136 grain few t4 it el�a5, <br /> a- YroN �y1 � �(7{ ��i 9 e0D0o557 , ' D (o, 92-1 pZ-IZgy, elf} I b16� c�BS-1644 ) <br /> inN%((I JI 071042110, <br />