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DUMMHU VGKI IHD <br /> �III DATE RECE � O\`�7 ,t�` EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY 0� <br /> ENVIRONMENTAL HEALTH DEPARTMENT n O <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 y <br /> �P y <br /> one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd v <br /> r�s�o PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: {ied,ap y BUSINESS/AGENCY: (1rZ444V_/, S <br /> ADDRESS: fN5z;) rnai,"Lo "4WOP CITYISTATE/ZIP: Suyi k'AwL% <br /> PHONE (1): PHONE (2):Loo 7/ —5713 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 buslnaos days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST•5 5 FEE(CASH OR CHECK ONLY)-RECUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List C1 Map-Descrip Ion: <br /> FILE ADDRESS EHD USE ONLY <br /> OI/ Street 0 Street Name City Unit 1 <br /> v— 1• ( _ frac Na- + <br /> 2. unit 2 <br /> rdnA <br /> 3. �d� I �J ( � i .5 t twfti . �. <br /> 4, Unit 3 <br /> 5. <br /> 6• /I]Unit 4 <br /> To view the HMMP(Hazardous <br /> B Materials Management Plan) go to the ❑ Units <br /> following website:www.sjoesdata.org <br /> 10. 'fUnh6 <br /> SpecYc Data Range of Information Requestetl: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> jpl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [71MEDICAL WASTE FACILITY SOLID WASTE FACILITVNENK:LE /I — <br /> y ®OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT WASTETIRE �� <br /> UNDERGROUND TANK(MONITORINOIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> Ali <br /> ABOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL �WASTEWATERTREATMENTPLANT <br /> HAZARDOUSWASTEIHAZARDOUS MATERIALS ❑MOTEIJHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> %*:— C TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> Q ❑TATTOOIBODY PIERCING ❑COMPLAIN71RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyiEw: MONDAY-FRIDAY 8:DD AM-S: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 /> hox(es). At least one file type MUST be selected. Fax to(2091484.0138 or mall to the address Indicated above. Address <br /> �... ranges will not be accepted-for additional assistance with file addresses,contact the EHO. Applications received after <br /> 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 /> 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 /> �y li� submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will he 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 /> ,111 <br /> M IiI "all Ism <br /> 118001%012 <br /> 0 I <br /> J_ I <br /> I <br /> Eio as-oa .:Z I-t r p�t-,H�•vhri iw z d•N 3: �(„� 9� re nc� -ryenf�ry /O&O j fh3�, rn' <br /> I c yed 1 an; LL. x((1 0. 2136 wl-ein 4AA- iq . - z� 5, <br /> a- I `Yrav a Q oo f ImT✓ 9 w000ss7 : o d b, C? -I i qZ-I zW4, 9v-1 blbi Ee-I6V8 I <br /> inN:(L7ro= 0710q It �i <br />