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c 11 12 06:01P Lee rk Fierce, Inc. <br />ATE [3ct:c`I7'ED0. _ SAN JOAQUIN COUNTY <br />tV ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />OFC 1 � 74lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www_sjgov.org/ehd <br />u <br />EHD LOG NUMBER <br />V <br />PUBLIC RECORDS RELEASE APPLICATION f <br />APPL CRNTM\�I�IDI� - ( BLISINESSIAGENCY: Lee- t � cke, C2 <br />ADDRESS: 33L{ S, YUSI( •^ k �� , S 1� /T� CITY/STATEIZIP: Cr�,Mc4e- 0- n1 �C4 <br />PHONE (1): 20`'j S 1 2c5 6D--76 PHONE (2): �l `f�t� 5312 FACSIMILE: 20 S CitIS 5�D7q <br />TENTATIVE' APPOINTMENT DATE: 45A> 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 (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUS ES DAYS <br />SIGNATURE OF APPLICANT_ li�"'-vf-, DATE 112/11112— <br />Electronic Information: ❑ List ❑ Map—Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />O Unit 1 <br />Street 4 <br />Street Name <br />City <br />1. <br />Unit <br />2. <br />1"'32 <br />Oce, v - e <br />3. <br />4. <br />i Li <br />�l y <br />0,00,ce� <br />Lc �4yv c <br />14 of?-- <br />i 1 <br />/ <br />O Unit a <br />Aj f <br />Unit4 <br />6.171 <br />7. <br />^ <br />?oF� u� l/s1 <br />ammPA <br />i \J ❑ Unit 5 <br />8. <br />j 20Lor <br />8and A) <br />wo <br />9. <br />To view the HMMP (Hazardous F) Unit 6 <br />10• <br />Specific Date Range of Information Requested: From Materials Management Plan) go to the <br />x ENVIRONMENTAL HEALTH DEPT following website: www.sioesdata.org <br />XI UNDERGROUNDTANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FAC <br />�LATHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br /><UNDERGROUND TANK(MONITORINGIREMOVAL]oZ_ ❑FOOD FACILITY <br />9,,,A��� <br />'''''B' <br />OOVEGROUNO TANK c",❑ CHICKEN RANCH[ DOG KENNEL <br />���rrrrrr,,,''''''''' <br />RDOUS WASTEMAZARDOUs MATERIALSo/- 1] MOTELIHOTEL <br />TIERED PERMITTED FACILITY D(- OOUSPA <br />] TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS <br />f <br />`1!5 <br />ASTEWATEERRnTREATMENT PLANT ftZy-{7- <br />❑ PUMPER TRUCKJYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY -FRIDAY 8:00 AM-5:011)PM (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 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 behold 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 USF; ONLY <br />FAM <br />�l1 B t�� ' E!r"7,FIiY►�54�S�/�i/►t rt L � �J ' Lo i./wl "I YOr• f / <br />% <br />IFIRIVIEW <br />. i A. �:��i� i 1 < :� �...[ ii 1► L.e <br />Received Time Dec. 11. 20 5:02PM No. 835 _ <br />Im <br />