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10/02/2012 TUE 9:07 FAX 2094682999 SJC Public Works 11001/001 <br />DATE RECEIVED <br />..'SAN JOAQUIN COUNTY <br />IV s ' ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />OCT qj W?Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EHD LOG NUMBER <br />1110 <br />ENVIf3DNhl►E�'6FtV C �t.`C'�', <br />PESMiT( PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: %pfrl cl /� APA 1,115 BUSINESS/AGENCY: !SA4-1:_' _p l; c- Ilifd,_45 <br />ADDRESS: i 0 /D r , ��(: r Cf' �/� �• i(i V _ CITY/STATE/ZIP: .5 j 0c k 0 e-- <br />PHONE (1): Z47 - r14 -30&6- PHONE (2)::<D'f FACSIMILE: ;,� <br />TENTAT/VE*APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST -/,$125 FEE (CAS OR CHECK ONLY) : REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT lgxl-, - = 1%../1 DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />J�- <br />FILE ADDRESS <br />EHD USE ONLY <br />©Unit 1 <br />Street # <br />Street Name City <br />1. <br />'S� <br />towel S �ve�fiO�Z <br />f ,;- <br />�. <br />NO <br />El Unit 2 <br />2. <br />C I Cj <br />3.. <br />4o <br />I] Unit 3 <br />4. <br />� �, <br />t <br />l,L v Ar <br />5. <br />a 10 <br />L�PUnit 4 <br />6. <br />h �' <br />A L t� �� % !� <br />7. <br />,.� <br />11 <br />' Unit 5 <br />8. <br />J, , fJ <br />i. c t f <br />O-Unit6 <br />10. <br />. J90 <br />1 3 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />,UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ZFHOUSING ABATEMENT [RSOLID WASTE FACILITYIVEHICLE <br />®- OTHER CLEANUP SITE (NON -LOP) FOOD FACILITY a -WASTE TIRE I� (Q_5 �(� 1 <br />® UNDERGROUND TANK (MONITORINGIREMOVAL)pt, DOG KENNEL gDAIRY��((��, I� I -t <br />© HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑ WASTEVfA�ER TREATMENT �LA. <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS. OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5: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 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 EHD. Applications received after <br />3:00 pm will be processed the next b- For adj4re5s :*k 1 + 6 " <br />2. The EHD will notify the applicant if ar N will be confirmed approximately ten (10) <br />days after receipt of application. The To view the HMMP (Hazardous ness days for review. Appointments <br />should be scheduled accordingly. Materials Management Plan) go to the <br />3. A file that is actively being worked or following website: www.sjoesdata.org ible 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 reorganizes oy tHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />