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in 05 2013 11:40AM Sage 9724809865 page 1 <br /> T EHD LOG NUMBER <br /> iyy <br /> D4 <br /> E 6 <br /> SAN JOAQUIN COUNTY <br /> LA VACNIVIENTAL HEALTH DEPARTMENT N <br /> EN N <br /> A r R 03 271 10 1.: <br /> 1868 EaSt Hazelton Avenue, Stockton, CA 95205-6232 <br /> V, <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> 1"10 N M01TAL' r i E '"l i-I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: K0)r.� 4A BUSINESSIAGENCY: 5/i/wr <br /> \4 1'� L <br /> ADDRESS: -7� L1e5�- CITYISTATEfZIP: <br /> PHONE (1): PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: L-00 13 Time: <br /> (Please allow 10 business days from clato of application submittal-'Tentative only must baroO�edj <br /> JM CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHEC Y) REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT— DATE <br /> Electronic Information: ❑ List D Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 7— nit I QU <br /> Street# Street Name city <br /> 1. f1 pWtyt r K r%,,1 <br /> 0 unit 2 <br /> 2. 4- <br /> 0 Unita <br /> 01C.-I J <br /> 4. <br /> 5. 11.1 IJZ <br /> f <br /> �4 <br /> 6. To view the HMMP (Hazardous <br /> 7. Materials Management Plan) please <br /> lit, go to the following website: <br /> www.simap.org/hazmatviewer/viewer.aSp <br /> 9. <br /> ED Unit 6 <br /> Specific Date Range of InFonination Requested. F,. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> (UST) <br /> UNDERGROUND TANK T)CLEANUP SITE (LOP) A'F MEDICAL WASTE FACILITY SOLID WASTE FACILITYfVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 HOUSING ABATEMENT ❑WASTE TIRE LU <br /> UNDERGROUND TANK(MONIToRiNoIREFOOVAL) 0 FOOD FACILITY Ej DAIRY <br /> ABOVEGROUND TANK F CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMEN4 LANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS U MOTELIHOTEL 171 PUMPER 7RUCKNARDICHEMicAL TOILETS <br /> TIERED PERMITTED FACILITY [:]POOLISPA IS LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING 12 Compl-AiNTIRESPONSE RECORDS []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:OOPm(EXCLUDING HOLIDAYS) <br /> 11. 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 riles exist. An appointment for review will be confirmed approximately ten(110) <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 conditign as released will be reorganized by EHD staff at the ex ense of the applicant. <br /> Future file reviews by the same applicant)may require a$125 deposit prior to review. Ii <br /> UMy <br /> M <br /> T Or <br /> Emb 4" <br /> d A <br /> Received Time Apr, 5, 2013 9:41AM No, 2751 <br />