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1 611/21/2013 3.13 PM FAX 14155977880 GEOLOGTCA FAX 1�0001/0001 <br /> ■ 1 � -� <br /> DATE RECEIVED E; D Lf NU BER, <br /> SAN JOAQUIN COUNTY <br /> RECEIVE� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 r <br /> Nov 2 a Z013relephorle. (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd � <br /> EWIRONMENTALHEi1LTH PUBLIC RECORDS RELEASE APPLICATION <br /> 1 6- <br /> APPLICANT: r-_ - f BUSINESS/AGENCY: `Coco *ge.•.. "V--- C- <br /> AD[3RESS: J _ Svi 22 CIYY/STATE/ZIP• _ orti rtrit i SCo . C Pi jH10' <br /> PHONE(1): `'�lS� � ��"�_ PHONE (2): FACSIMILE: <br /> TENTATIVE"'APPOINTMENT DATE: Time: �- <br /> (Ploaso allow 10 business days from data of application Submittal-'Tanfativa only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOUEST-$125 FEE(GASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAVE L 1 2a i-S <br /> Electrooic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EMD USE ONLY <br /> street+► Street Name City Unit 1 <br /> O F2. <br /> o'p ©Vnit2 .A <br /> 3. ewax- fib,_. 1�1' �u�uk a r�cam <br /> r /�1L <br /> 'dun it <br /> 3 <br /> l <br /> f <br /> -- — � llnit 4 <br /> 7. i/ <br /> ❑unit s <br /> lo, <br /> ❑Unit 8 <br /> Spocifle Dat*Riounge of Information Requested: Fromto <br /> ENVIRONMENTAL HF„ALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SETE(LOP) ❑MLOICAL WASTE FACILI>•Y ❑SOLID WASTE FACIU YNEHicLE { <br /> R CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE - ' <br /> B U EROROUHD TANK(MONITORINGIREMOVAL) ❑FOOD FACIL9Y -1bAIRY <br /> migs'OVEGRouxD TANK ❑ClilcKE:N(RANCH/DOa KENNEL ❑WASTEWATER TREATMENT PLANT 14 <br /> AZARDOUS WAsTEIHAZARDOUS MATERALS ❑Moiki./HOTEL [3 PUMPER TRUCKIYAMICHEmicAL TOILETS <br /> ❑TIERED PERMrrrFi)FACILITY ❑POOLISPA ❑LAND USE APPuGAT10N SITES <br /> ❑TATToolBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEI>YJC PERMIT RECORDS ARE AVAILASLE FOR REvIEw: MONDAY-FRIDAY 8:00 AAA-5:00pm (EXCLUDTNC HOLIDAYS) <br /> 1. LI§j M12 to ion addreHes In the space above. Select the types)of NOS frorn the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12g2)jfA:0138 pr mall to the ejqdress Indicated above. Address <br /> ranges will not be accepted,-for Additional assistance with file addresses,contact the EHp, Applications received after <br /> 3:00 pm Will be processed the next business day, <br /> 2. ,The EHD will notify the applicant If any EHp files exist. An appointment for review will bo confirmed approximately ten(10) <br /> days After receipt of application. The files will be held for a maxlmurn offive business days for review. Appointments <br /> should be scheduled accardingly. <br /> 3. A file that is actively teeing worked on by EHD staff may not be immediately available for review. A new application may bo <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 ex ionse of the applicant. <br /> •Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> e A <br /> we <br /> 6MD Daae <br /> 4574 <br /> Received Time Nov, 20. 2013 2: 14PM No. °'°"_ <br />