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04J26I201 12'154 8313383666 <br />DAITE��EIVED— <br />N <br />SINCERELY YOURS <br />SAN JOAQUIN COUNTY <br />APRX' <br />2013 ENVIRONMENTAL HEALTH DEPARTMENT <br />Tele1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />phone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.org/ehd <br />`E"T.:!'1IJ; S <br />PUBLIC RECORDS RELEASE APPLICATION <br />PAGE 01/01 <br />EHD LOG NUMBE`RR <br />4 <br />PHONE (1): PHONE (•2) FACSIMILE: <br />TENTATIVE` APPOINTMENT DATE:SJ Time: <br />(Please ellow 10 bualness days from dte f appll atI su I -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - S125 OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSI PES S AY5 <br />SIGNATURE OF APPLICANT �— DATE ( 7 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE QN1_Y <br />Unit 1 <br />Street * <br />Street Name <br />City <br />_57 Lf <br />/ic❑unit x <br />2. <br />3. <br />-- <br />(] Unit 3 <br />4' <br />5. <br />To view the HMMP (Hazardous <br />Materials Management Plan) please U'unita <br />go to the following website: <br />www.sjmap.org/hazmatviewer/viewer.asp ❑ Unit 5 <br />❑ Unit 6 <br />6. <br />7. <br />8' <br />9. <br />10. <br />WELIR, <br />Date Range of Information Requested: From �!"r (/ tv <br />ENVIRONMENTAL HEALTH D NT FILES <br />OROUND TANK (UST) CLEANUPS�TE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILRYNEHICLE CLEANUP SITE (NON ❑ HOUSING ABATEMENT ❑WASTE TIRE Zfj (�S/' �{ 3 <br />GROUND TANK (MONITORINGIREMOVAL).1 ❑ FOOD FACILITY ❑ DAIRY)/�'� k�JAWVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />AZARDOUS WASTEIHAIARDOUS MATERIALS ❑ M0 EL/HOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />�-ry <br />fERED PERMITTED FACILITY r L__I POOLISPA ❑ LAND USE APPLICA11ON SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTiRESPONSE RECORDS ❑ OTHER (PLEASE SPFCIFY) <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 fist above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 4U,2J38 or mail to the address indicated above, Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EMD. 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 reviews by the same applicant may require a $125 deposit prior to review.' ",!3'Mb-"A' F!si 'fil iNILY <br />�l.�a�� 1/(ft)/I 1 iClSui rr+�fi (,��� ��'�'' .dor Cfl►. c� iJr t '� � v <br />f 'EYROt pT did tl,.fi!y i 'pF tA+otlttpfe A tl'Ivbrtiei . 1 <br />Received Time Apr. 26. 2013 2:07PM No.2962 <br />e1w1z <br />