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FROM:Chemstation TO:4640138 01/07/2013 16:41:47#26863 P.001/001 <br /> I EHD LOG NUMBER <br /> �� <br /> ��� � E® SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN 07 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ��li <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd V <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7y � <br /> 14F ..,._, BUSINESSIAGENCY: � 7/7mvr <br /> ADDRESS: y/3 —E {9vt H e CITY/STATE/ZIP: L,�S f'o DSZ�3 <br /> PHONE(1): 7oy- PHONE(2): FACSIMILE: -,-of - 9"- 7zs70 <br /> TENTAT/VE'APPOINTMENT DATE: 3 Time: ew Z:Do Pi`7 <br /> (Please allow 10 business days from data of appli atlon submittal.'Tentative only-most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-S125 FEE OR C ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 117113, <br /> Electronic Information: El List Map- ascription: <br /> FILE ADDRESS EHD USE ONLY <br /> i Streets Street Name City <br /> ,. r � yy Shower .................... <br /> � <u�►h ,,Imi�� , <br /> Or2. ._....._. ............... ......... ......-............ . ..... una2 <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> . To view the HMMP (Hazardous unii,l <br /> 7. Materials Management Plan) go to the <br /> 8. 1 following website:www.sjoesdata.org <br /> _ ❑Unit 3 <br /> 9. <br /> 10. Unit e <br /> Specific Dale Range of Information Requested: From / -- O /— /9 G t0 Z>1 - O 7 - D <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �t1NDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABA7 EMENT $OLIO WASTE FACHMIV HICLE <br /> ❑v'OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE �py <br /> iw DERGROUND TANK(MONITORINGIREMOvAL)� ❑DOG KENNEL ❑9AIRY <br /> L��J-/i{AZARDOUS WASTE GENERATORc�- ❑CHICKEN RANCH [�'tty STEWATER TREATMENT PLANT Z <br /> TIERED PERMITTED FACILRY� ❑MOTELIHOTEL ❑ MPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑,POOUSPA �ND USE APPLICATION SITE <br /> ❑ MEDICAL WASTE FACILITY [9COMPLAINT RECORDS OTHER(PLEASE SPECIFY) e V'W"f 1-4/ <br /> �P _s <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-$:00PM(EXCLUDING HOLIDAYS) <br /> t. List up to ten addresses In the space above. Select the type(s)of Hies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091464-0138 or mall to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with Nle 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 Flies exist. An appointment for review will be confirmed approximately tan(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 /> 111114-.i1 UNI', <br /> -1 n _lf <br /> 'r, n y <br /> No N-W yhn t <br /> Received Time Jan. 013 3:53PM No. 2037 <br />