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'6Z -U�rALaW11 paA 143
<br /> DATE RECEiVEU SAN .JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> )AN 7013 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd
<br /> PUBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT:__A4_ 4_6_ ria BUSINESS/AGENCY: �,^tQ,�
<br /> ADDRESS: 34f3q ,+ '4t- C CITY/STATE/ZIP: ,►, � �1S'T�
<br /> PHONE(1); PHONE (2):rjj,,)M— -Sq -40 FACSIMILE: CR16) • o- 0�3
<br /> TENTATIVE'APPOINTMENT DATE: Time:
<br /> (Please allow 10 business days from date of application sybmlttal •Tantative only-must be confirmed)
<br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT h--�' DATE i t4 t
<br /> Electronic. Information: ❑ List ❑ Map—Description:
<br /> FILE ADDRESS EHD USE ONLY
<br /> Strecl# Street Name City unit 1
<br /> 2. _ �:
<br /> .r Unit 2
<br /> ���
<br /> Unit 9
<br /> 5.
<br /> - To view the H M M P (Hazardous
<br /> 7• Materials Management Plan)go to the
<br /> 8. following website: www.sjoesdata.org '
<br /> 10. uUnit e
<br /> F
<br /> Specific Data Range of Information Re®uestcd: From ('loo to rare.sa
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES V
<br /> DERGROuNo TANK(UST)CLEANUP Sr(E(LOP) �✓1EDICAL WASTE FACILITY JOLjD WASTE FAg4M1VEHICLE r
<br /> [��RHER CLEANUP SITE(NON-LOP) [�WASTE TIRE ;� �'-`' (Ur(X/
<br /> TANK(MONITORINGIREMOVAL) AIRY -I
<br /> 9�4DERGIROUNI:l
<br /> OVEGROUND TANK �HICKEN RANCH/poo KENNEL [ 'WASTEWATER TREATMENT PLANT
<br /> 21q ARDOUS WASTE/HAZARDELI
<br /> WASTE/HAZARDOUS MATERIALS R4OTHOTEL EUMPER TRUCKNARo/CHEMICAL TOILETS
<br /> [� IEREO PERMITTED FACIL" Q^POOLISPA 21] AND USE APPLICATION SITE
<br /> g<A1TOO/BODY PIERCING 9<5NIPLAINNRESPONSE RECORDS Cj�OTIIER(PLEASE SPECIFY)
<br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR ReviEw: MONDAY-FRIDAY 8:00 AM-5;00PM(EXCLUDING HOLIDAYS)
<br /> 1. List uR 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(2091464-0138 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 flies 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 ftwe 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 a��llcant
<br /> Future file reviews by the same applicant may require a $125 deposit prior to review, � 81,0' D A EH}D USE„ONL.,
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