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Paul Humphrey, R",\, CAC 5" ')26-3408 p.1 <br />19LOD EHD LOG NUMBER $ <br />f /CD SAN JOAQUIN COUNTY <br />V C ENVIRONMENTAL HEALTH DEPARTME T '+• ' <br />1868 East Hazelton Avenue, Stockton, CA 952056232 <br />111112013 Telephone: (209} 468 3420 Fax: (209) 464-0138 Web: wwwsjgov.org/ehd . . <br />ENVIRONMENTALPERM;/SERV[ EALTf! PUBLIC RECORDS RELEASE APPLICATION <br />PERMIT/SFRy_IrFc , <br />APPLICANT: .9 � by BUSINESS/AGENCY: <br />ADDRESS: _7i�Z E QJ 2'�i CITY/STATEIZIP: F�GV"o <br />PHONE(1): D5 1 qq-)7-g913 PHONE (2): FACSIMILE: -599 2Z-6-3 Q8 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please alloW 10 business days from date of application submittal - TeMaHve only - must be co .mled) <br />❑ CHECK BOX TO EXPEDITE REQUEST- $125 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />UF <br />Electronic information: ❑ List ❑ Map —Description: <br />FILE ADDRESS EHD USE ONLY <br />Street ,# - Street Name City ❑Unit <br />1. <br />3) 5- <br />S w nF <br />Al J <br />z. <br />be - 1 Ak)ee1c12 <br />a. <br />3 <br />F,e <br />z <br />m M /m <br />�tIn t <br />4. <br />6 <br />�PfUnit4 <br />6. <br />,7 <br />s. <br />❑Unit 5 <br />8. <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY <br />Ej OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILfn'NEHI LE //,, -- <br />�UNDERGROUNDTANK(MONRORINGIREMOVALV— ❑FOOD FACILTIY �WA Y TIRE !j � �/Wl1�3. <br />R ABOVEGROIUHD TANK c. ❑ DAIRY f '� _ Z 7' N <br />TT ❑CHICKEN RANCH/ DOG KENNEL ,� WASTEWATER TREATMINf PLANT <br />Z9HAZARMUS WASTEIHAZARDOUS MATERiALS�'❑MOTELHOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />�;1 TIERED PERMITTED FACILITY OL ❑ POOL/SPA J91 LAND USE APPLICATIDN SITES <br />TATf0019ODY PIERCING f�j COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 6:00 AM-5:00PYA (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) 46"138 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 EMD 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. BOXED AREA- EH13 USE ONc v <br />- - ( o v (c <br />; couol d W ,, uc .5 <br />la -30-13'. G <br />in dd lv�4q <br />O Reco ds provided -by -S <br />Received T(me Dec. 18. 7018 <br />WAA '_0 0 s <br />-PPR.. omplete. Sa Name: <br />6:MPM'No.4809 91412 <br />