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NOV 07 2v1$ <br />01 1 2- <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />to '7. i t Specific Date Range of Information Requested: From <br />DATE <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />ENVIROMENTALT40#13Ppne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br />PERMIT/SERVICE S. <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />5010 <br />APPLICANT:Motrn (L1/‘ BUSINESS/AGENCY: 204.fA ()L. 12cd.1o11 <br />ADDRESS: 1 a s h.chrteA -4-1e.C..1-1 Su I h - CITYJSTATE/ZIP:1::....,hcAi-or) (fi Gk..%) <br />PHONE (1): (..:/0°1) 3ag 3 PHONE (2): FACSIMILE: A 1;14, <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />LI CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHNCK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 1f\4±_ac\n7 a DATE t IA-1-1-7 /1 c- <br />1 Electronic Information: LI List LI Map — Description: <br />I <br />Street # <br />FILE ADDRESS <br />Street Name City <br />EHD USE ONLY <br />Unit 1 <br />E] Unit 2 <br />' l'2)141 s 'al---Pib 54 . Sil 6k10 <br />si-bcd‘con ,;Q as' 1Af Rier )..D zrA <br /> <br />4' <br />V•\ \4*17 <br />CI UnIt 3 <br />Et SITE MITIGATION <br />/V. ct (A a V-1._'0 I.1 anr1 reve3h 4 <br />0 <br />cAc 04. elm' . bop 1.esk0 4 <br /> rc na.,241 ,, 4.s;_1_ I:7"AL 4.c.RAm.,1.) ' t--.4 in 0 sts/ e t. rtille <br />Gueirefo CI Unit 4 <br /> 60 0.1 <br />---- <br />\ 8• SQ 1 1e111.1 !Mil- It S a- vq-i l`d 3 — ..-.) (133 Unit 5 <br /> <br />' no' <br />, m onit-6- I' I. <br />['UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />El OTHER CLEANUP SITE (NON-LOP) <br />El UNDERGROUND TANK (MONITORING/REMOVAL) <br />LI ABOVEGROUND TANK <br />D HAZARDOUS WASTE/HAZARDOUS MATERIALS <br />El TIERED PERMITTED FACILITY <br />El TATTOO/BODY PIERCING <br />E] MEDICAL WASTE FACILITY <br />ELHOUSING ABATEMENT <br />7KI FOOD FACILITY <br />EltHICKEN RANCH/ DOG KENNEL <br />El MOTEL/HOTEL <br />LI POOL/SPA <br />El COMPLAINT/RESPONSE RECORDS <br />El SOLID WASTE FACILITY/VEHICLE <br />Ei WASTE TIRE <br />El DAIRY <br />El WASTEWATER TREATMENT PLANT <br />El PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />LI LAND USE APPLICATION SITES <br />[3 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00Pm (EXCLUDING HOLIDAYS) <br />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 (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />The EHD will notify the applicant if any El-ID 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 />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. "'BOXED AREA - EHD USE ONLY"' <br />0 Records provided by Staff-PPR Complete. Staff Name: <br />EHD 48.06 <br />5111115