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EHD LOG NUMBER <br /> DAT RE IVED SAN JOAQUIN COUNTY <br /> R E. V EIViRONMENTAL HEALTH DEPARAMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JAN 29 2013Telephone: 209 468-3420 Fax: (209)464-0138 Web: www.sjgoNt.org/ehd <br /> ENVIRONMENTALPERMERVIC SLTFI PUBLIC RECORDS RELEASE APPLICATION <br /> :( �APPLICANTBUSINESS/AGENCY: C"LA-t-111TCON <br /> ADDRESS: YZZ W - _\A-#^ CVdat°tj-b{ CITYISTATEIzIP: / G <br /> PHONE (1): V'7-343- S" fz- PHONE(2): IJV,',In`IW x22-gFACSIMiLE: 15-10) <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITER ST-$125 FE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B. SINE DAYS <br /> SIGNATURE OF APPLICAN DATE I- <br /> Electronic information: ❑ Lis ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> StreetStreet Name City ❑Unit1 <br /> op, 1. Cj <br /> �L 2. 22 N) It2 <br /> 3. �4t.1 1 , <br /> 4. 0Unit 3 <br /> 5. <br /> 5 nit 4 <br /> 7. To view the HMMP (Hazardous <br /> g. Materials Management Plan)go to the ❑Unit 5 <br /> 9. following website:www.sjoesdata.org <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY E]SOLID WASTE FACILnYNEHICLE /� <br /> THERCLEANUP SITE(NON•LOP) HOUSING ABATEMENT ❑WASTE TIREY fr IP5f r1 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) <br /> FOOD FACILITY ❑DAIRY 6t/1'/j'3ABOVEGROUND TANK "/� F]CHICKEN RANCHI DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> �•IAZARDOUSWA5TEIH�'s yt ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA W LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 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 Ole 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. ""BOXED AREA-EHD USE ONLY— <br /> 4- A5 s <br /> GOOD /55 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: x14112 <br /> EHO 4"S <br />