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6m�c 11 12 06:01P Lee & Pierce, Inc. 2098488274 p.1 SATE E',`�Sr�1VffD e'DSAN JOAQUIN COUNTY EHD LOG NUMBER r� 9�, r-11 ENVIRONMENTAL HEALTH DEPARTMENT.91k is V 1868 East Hazelton Avenue, Stockton CA 95205-6232 24�lephone: (209) 468-3420 Fax: 209 464-0138 Web: www.s' ov.or lehd ( ) J9 9 PUBLIC RECORDS RELEASE APPLICATION T6—irT as - i APPLIC�iI�tT: �pY�,n LQ v� e , BUSINESSlAGENCY: Lei Ir e"C2 I V�( ADDRESS: `3�Li S, �us�t� �v2� Sc.� �� CITYISTATE/ZIP: Cla I c"6 C (Il PHONE (1): 20 '61 `j &7p PHONE (2): FACSIMILE: 2e TENTATIVE* APPOINTMENT DATE: 45A�> Time: (Please allow 10 business days from date of application submittal -''Tentative only --must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST - $1251 E (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUS ES DAYS SIGNATURE OF APPLICANT DATE 12 J ( 2- II Electronic Information: ❑ List ❑ Map—Description: Specific Date Range of Information Requested: From Materials Management Plan) go to the ENVIRONMENTAL HEALTH DEPJ following website: www.sjoesdata.org UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FAC :HICLE jj r OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT I l UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY DAIRY AeOVEGROUNDTANK off_ ❑ CHICKEN RANCHIDOG KENNEL ;RW ASTEWATERTREATMENTPLANT HAZARDOUS WASTEIHAZARDOUS MATERIALSv/— ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS TIERED PERMITTED FACILITY ✓ ( OOVSPA E] LANE) USE APPLICATION SrrES TATToO(BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELLAND 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. ***BOXED AREA- EHD US ONE,�LY w � � ' _.l ,y ,� :1 L .� �J '.tea � ,v • i • � � Street # FILE ADDRESS Street Name City EHD USE ONLY ❑ Unit 1 []/' Unit 2 2- 1533 2 F 1�� L 2va 4. i y `"( [,IST I { `, O' J ♦ Unit 5- X55 e,� �� e .rte N . F. F. L,, No ) ] Unit 6. 7. 5 20 20� N� �� I�mM�', " [I Unit 5 To view the HMMP (Hazardous [p Unit s 9. 10. Specific Date Range of Information Requested: From Materials Management Plan) go to the ENVIRONMENTAL HEALTH DEPJ following website: www.sjoesdata.org UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FAC :HICLE jj r OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT I l UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY DAIRY AeOVEGROUNDTANK off_ ❑ CHICKEN RANCHIDOG KENNEL ;RW ASTEWATERTREATMENTPLANT HAZARDOUS WASTEIHAZARDOUS MATERIALSv/— ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS TIERED PERMITTED FACILITY ✓ ( OOVSPA E] LANE) USE APPLICATION SrrES TATToO(BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELLAND 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. ***BOXED AREA- EHD US ONE,�LY w Received Time Dec.11. 20 5:02PM No. 835 41 I � � ' _.l ,y ,� :1 L .� �J '.tea � ,v • i • � � Received Time Dec.11. 20 5:02PM No. 835 41 I