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■ <br /> I -234-0538 0538 Line • 11 16 a.m. 10-23-2012 111 <br /> DATE RECEIVED EHD LOG NUMBER <br /> ■ R SAN �JOAQUIN COUNTY <br /> ` '���'��® ENVIRONMENTAL HEALTH DEPARTMENT <br /> UL 12.p�2 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENWRONMENTAIHEAM <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:1 �G(J��— BUSINESS/AGENCY: <br /> ADDRESS: S��CITY/STATE2IP: ( � Glf QSZ� <br /> PHONE(1):- ;?Yf-23��/yOHONE(2): -Z-6YO / FACSIMILE: -053,F <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 EXPEDITE REQU 25 F (CAS<OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS[ ESSDAYS <br /> SIGNATURE OF APPLICANT DATE l0 /Z <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 9 1. 6137 by C ,,AcN si S nON loo li{ti i 3o I 1 <br /> 2. CU/ -� r Joek 0 UnLit2 <br /> 4. <br /> Oo s �,ti�o�� 57r3 sJ uunit <br /> G <br /> 5. fDI s ILQ) U h-T�' -7 I 1pe, ^1 <br /> 6. �S 5 J]l��S !J S j rO A/OG41 Unit4 <br /> 7. V� — dJilsifl�j5 ID <br /> 8, -tqr q {# 0` To view the HIVIMP(Hazardous ❑ Unit 5 <br /> 9 Materials Managemeht Plan)go to the <br /> n following website:www.sjoesdata.org <br /> 10. <br /> ❑'Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES y-7 <br /> `- CVNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ----❑HOUSING ABATEMENT '-- SOLID WASTE FACILITYINE L <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE <br /> UNDERGROUND TANK(MONITORING/REMOVAL, ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR O( ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY©C ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TATFo01BODY PIERCING ❑PooUSPA ❑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-5:00PM(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 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 file 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. <br /> C066 I a?07 L (75! ✓ ` D /1t <br /> COP (/)5 51 4-a-97 Ole v, a <br /> Received Time—Oct. 23. -2012-11 :26AM—No. 1470 ann, <br />