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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQIN COGNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ^,� l`ereph1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elf Y one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ��\\ <br /> Q PUBLIC RECORDS RELEASE APPLICATION / <br /> APPLICANT: D"I t IJD�� BUSINESS/AGENCY: &A f��3or�d }`tis <br /> ADDRESS: -b�(B2a F�02 CITY/STATE/ZIP: f� 41-101-1 ('741f,���°Z <br /> PHONE(1): j�(? y/�' � �� PHONE(2): ]` 30 y�3-<::,f 5_ FACSIMILE: 530-G33 -O) f'7 <br /> j' TENTATIVE*APPOINTMENT DATE: A.5 � t a 5 ��J/�a,- Time: <br /> (Please allow 10 business days from date of application submi I-*Tentative only-must be confirmed) <br /> (❑ <br /> fzLJ ,CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT- ,Rk'th\/t 4ry'�- - ( Lh( Vi�U /1 DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS HD USE ONLY <br /> Street 4 Street Name City \ A 096b <br /> Unit 1 <br /> 2. <br /> 3. M I fir' <br /> 4. <br /> r <br /> 6. �,❑Unit <br /> 7. <br /> To view the HMMP (Hazardous El Unit s <br /> 9 Materials Management Plan) go to the <br /> 10. following website: www.sjoesdata.org 0 <br /> k Unit 6 <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACI /VEHICLEJ, _ <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT �CWASTE TIRE I) �7 /19r7 <br /> UNDERGROUND TANK(MONITORING/REMOVAL/4- ❑FOOD FACILITY F]DAIRY K-.A- i_P <br /> ABOVEGROUND TANI�ti ❑CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLA T <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS,�� ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING S5�COMPLAINVRESPONSE 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(209)464-0138 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 /> 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 Views by the same applicant may require a$125 deposit prior to review. —BOXED AREA-EHD USE ONLY <br /> 1 F - 1 0.0 <br /> )Uc M( I r l 1� <br /> GAP 4 ;1 _(w <br /> (DII aq- <br /> ❑ Records provided,by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 TqfflC6 i j00 ,LQ,A,�t4QA � IAL+�V� . �' , P7Z�8, �Z `(' IV/- <br /> GpE z l 7, , 7�X37 T <br /> 1 <br />