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N 01/22/2013 10:48 9254260106 BUREAU VERITAS PAGE 01 <br /> ■ <br /> ■ <br /> Oft <br /> MooDATERECE�V '\ p�� EHD LOG NUMBER <br /> ti% SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 002 <br /> f��vU205-6232 <br /> 1868 East Hazelton Avenue, Stockton, CA 95 <br /> 01 <br /> phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or91ehd <br /> �0 4 . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: iYLt U <br /> ADDRESS: lg5olln�n;�.o Q{� CITY/STATEZIP: <br /> 3 <br /> PHONE (1): PHONE (2):l_:J4-�/e)—5`M3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tewfatwa only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$ 5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ Li: p Ion: <br /> FILE ADDRESS EHD USE ONLY <br /> O� Street# Street Name City Unit 1 <br /> 1. Lt4 7 <br /> 2. <br /> 0 Unit 2 <br /> 3. l got) J s• �' � �•, <br /> 4. Unit 3 <br /> 5. <br /> 6. :❑Unit 4 <br /> 6 To view the HMMP(Hazardous <br /> t3 i Materials Management Plan)go to the <br /> 171 Unit s <br /> 9 following website:www.sjoesdata.org <br /> 10. sp Unit <br /> _n Specific Data Range of Information Requested, From to <br /> \ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILINIVEHICLE <br /> [�OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT IWAsTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) El FOOD FACILITY El DAIRY <br /> �CABOVEGROUND TANK C1 CHICKEN RANCH/DOG KENNEL ZI WASTEWATER TREATMENTPLANT <br /> Q HAZARDOUS WAs EIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTooIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE:FOR REVIEW: MONDAY-FRIDAY 5:00 AM•S:OOPM (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 We MUST be selected. Fax to!2091464-0138 or mall to the address indicated above. Address <br /> i_'�s ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> V\ 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 tan(10) <br /> l� 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 reviews by the same applicant may require a$125 deposit prior to review. , Il� <br /> O' <br /> ill i I ,IIS I I, I � ' I' If I N I� � � '➢ ! I <br /> ergo 4s-0a <br /> d T o 2136 u <br /> ( ln <br /> RPc i eme �an�'�h�(f13 � �� N . vein Nom, 4>013zT5 <br />