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0 ;c 11 12 06:01p Lee & Pierce, Inc. 2098488274 p.1 <br /> INNATE 2 C'1VE'D EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> I)) <br /> $'14lephone: (209) 468-3420 Fax: (209)464-0138 Web: wwwsjgov.orglehd % <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICW. Jo"I, . �3 v�e BUSINESSIAGENCY: Lee <br /> '--,�_ r��`2 Vit <br /> ADDRESS: `3�� S, uS�� �y2� Sc CITYISTATEIZIP: C��(JO•.(0 <br /> PHONE (1): 20( '61b SDL76 PHONE (2): � q� -) S31Z FACSIMILE: 20 <br /> TENTATIVE*APPOINTMENT DATE: 65Af > _ Time: <br /> (Please allow 10 business days from dale of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSPESP DAYS <br /> SIGNATURE OF APPLICANT DATE 12 I (/(2— <br /> Electronic <br /> ZElectronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1 i <br /> 2' 1833 �,-l`��I�+tL Q i `t 0� v �, ❑/ Unit 2 <br /> 3. <br /> y � 4 i <br /> 4. 171 Unit3 <br /> 6. <br /> El unit <br /> 7. fF � <br /> ❑Unit 5 <br /> 9- <br /> 14. To view the HMMP (Hazardous )] Unit 6 <br /> Specific Date Range of Information Requested: From Materials Management Plan)go to the <br /> ENVIRONMENTAL HEALTH DEP) following website:www.sjoesdata.org <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP( ❑MEDICAL WASTE FAC :HICrLE r <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT I J <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL),�— ❑FOOD FACILITY ❑DAIRY (,tp <br /> AeOVEGROUNDTANK C<- ❑CHICKEN RANCH[DOG KENNEL 2 ASTEWATER TREATMENT PLANT <br /> I HAZARDOUS WASTEINAZARDOUS MATER1ALSoL- ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEFAICALTOILETS <br /> TIERED PERMITTED FACILITY D(- OOUSPA ❑LAND USE APPLICATION SrTES <br /> TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND 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 list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EFID. 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. Anew application maybe <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. *'"BOXED AREA-EHD U5 ONLY <br /> a _ <br /> J ` ) ( 1 } ,u r712A -P-and O �� <br /> Le <br /> u� Miz 'I IJI P, I a, <br /> < <br /> Received Time Dec. 11, 20,1� 5 :02PM No. 1835 <br />