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01:4/:SVP.m. ' " "tHU LUti NUMBtR <br /> -234-0538 Line 1 <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTKENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ,NOV 27 2012Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd C <br /> EN%FWNMENTALHEALTH <br /> `I:"MITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4< �/T/r BUSINESS/AGENCY:���N�Iy�UU� fY// �P <br /> ADDRESS: CITYISTATE/ZIP:_ %Grimm �/U �6/L <br /> PHONE(1): Q Z-1f OSI g PHONE(2): lo��` 63 FACSIMILE:-; <br /> TENTAT/VE"APPOINTMENT DATE: �f U ' 2 Time: L <br /> (Please allow 10 business days from date of application submhtal-'Tentative only-must be confirm d) <br /> HECK BOX TO EXPEDITE REQUEST- EE(C OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU (NESS DAYS <br /> SIGNATURE OF APPLICANT DATE N <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city 13 Unit 1 <br /> 1. ago S. N r© S G � Now <br /> 2. /�,e' fish ' ` o t2 <br /> 3. E /DRi/�A R <br /> 4. �/9/P/��b r Gl �� Jnit3 (� <br /> 5. r <br /> 6. 561 — ' I r qui I✓i IJ 1 nit4 <br /> 7. <br /> 8. To view the HMMP (Hazardous ❑unit <br /> y Materials Management Plan) go to the <br /> 10. following website:www.sjoesdata.org ❑Unit <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE(� '^ <br /> 'EjQTHER CLEANUP SITE(NON-LOP) �� // ❑FOOD FACILITY El WASTE TIRE � h�25 �/((i,1 3 <br /> �11NDERGROUNDTANK(MONITORING/REMOVAL)c4 ❑DOGKENNEL ❑DAIRY 121(,�j/Jyio <br /> Z, kAZARDOUS WASTE GENERATOR p� ❑CHICKEN RANCH ❑WASTEWATERTREATMENT PLRNT. <br /> ❑TIERED PERMITTED FACILITY 0(_ ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TAT oOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑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(2091464-0138 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 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 /> j 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 /> Y r <br /> I, IL r u U I ( 4th Z d 1( <br /> )A f 1 7 6 GIO <br /> i-a45`I F <br /> Received Time Nov. 27. 2U12 Q: No, 110311 7(1 (Z� (U 4„ <br />