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�Clc 11 12 06:01p Lee & Pierce, Inc. 2098488274 . SATE E?--c';tH1VE�D SAN .10AQUIN COUNTY .. r� ENVIRONMENTAL HEALTH DEPARTMENT � y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 $ `L4�lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd �V PUBLIC RECORDS RELEASE APPLICA'(lON \V\ JJJJJJv` P.1 EHD LOG NUMBER APPLIC�i ID�"� t�6-� e . BUSINESSIAGENCY: i _C}Q' ADDRESS: `3�Li S. uS� �y2, Sc.{ CITYISTATEIZIP: C� Cid A C7 (1! PHONE (1): 20 f 161b &M PHONE (2): 21 ' ` '-) 5312 FACSIMILE: 20 5yl) �7 TENTATIVE* APPOINTMENT DATE: Time: (Please allow 10 business days from dale of application submittal -'"Tentative only- must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST - $125 F E (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUST ES DAYS SIGNATURE OF APPLICANT DATE 1z 1 ( Z Electronic Information: ❑ List ❑ Map —Description: Specific Date Range of Information Requested. From Materials Management Plan) go to the ENVIRONMENTAL HEALTH DEP/ following website: www.sjoesdata.org UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FAC :HICLE JTAE THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT UNDERGROUND TANK (MONITORINGIREMOVAL)� El❑FOOD FACILITY DAIRY O a•� �CA� 1ZZ�-(Z. OVEGROUNDTANK C� ❑CHICKENRANCHIDOGKENNEL n (VASTEWATERTREATMENTPLANT AZARDOUS WASTEIHAZARDOus MATER1ALStZ ❑ MOTELIHOTEL ElPUMPER TRUCKIYARDICHEMICALTOILETS IERED PERMITTED FACILITY D( OOLiSPA E]LAND USE APPLICATION SITES ATTOOIBODY PIERCING COMPLAINTIRESPDNSE RECORDS ❑OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact the EFID. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $125 deposit prior to review. '91OXED AREA--EHD USF ONLY 24- J2111.00 MIUMPOW111, �§! ff"90101 WMITIMMMM, 1711701 "12 Received Time Dec.11. 204 5:02PM No. 835 e) aw Street # FILE ADDRESS Street Name City EHD USE ONLY Unit 1 l�-{�^� � Ej Unit 2- 2. j33 S 1 � 1 � `��'��-- Q 3. 4. i 5 q `4 L uli4lb ft -ad TO jIA (] Unita 5. O Unit d 7. "L �o� Ib� El Unit 5 8. 9. To view the HMMP (Hazardous p Unit s 14. Specific Date Range of Information Requested. From Materials Management Plan) go to the ENVIRONMENTAL HEALTH DEP/ following website: www.sjoesdata.org UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FAC :HICLE JTAE THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT UNDERGROUND TANK (MONITORINGIREMOVAL)� El❑FOOD FACILITY DAIRY O a•� �CA� 1ZZ�-(Z. OVEGROUNDTANK C� ❑CHICKENRANCHIDOGKENNEL n (VASTEWATERTREATMENTPLANT AZARDOUS WASTEIHAZARDOus MATER1ALStZ ❑ MOTELIHOTEL ElPUMPER TRUCKIYARDICHEMICALTOILETS IERED PERMITTED FACILITY D( OOLiSPA E]LAND USE APPLICATION SITES ATTOOIBODY PIERCING COMPLAINTIRESPDNSE RECORDS ❑OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact the EFID. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $125 deposit prior to review. '91OXED AREA--EHD USF ONLY 24- J2111.00 MIUMPOW111, �§! ff"90101 WMITIMMMM, 1711701 "12 Received Time Dec.11. 204 5:02PM No. 835 e) aw