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- - ------------ ...... ------ ... ----- <br /> �� Paul Humphrey, R#CAC 5 26-3408 p.1 <br /> f d'h <br /> � <br /> ■ T EIVED - t.' `+"'. EHD LOG NUMBER e <br /> L' r q SAN JOAQUIN COUNTY v <br /> ENVIRONMENTAL HEALTH DEPARTMENT Yz ,� <br /> DEC 1 9 P013 1868 East Hazelton Avenue,Stockton, CA 95205-6232 ?�< <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd t - <br /> ENVIRONMENTAL <br /> HE_, <br /> PERMIT/SFRVIRFC PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: F6L111__.AA IM /Ly BUSINESSIAGENCY: <br /> ADDRESS: ��D2.. �, ( ;it?v✓) CITY/STATErZIP: Fe' VL-,3 <br /> PHONE(1): j5 1 (7I-/913 PHONE(2): FACSIMILE: 55'1 2Z63 8 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tenfafive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-.5125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: [] List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Q Unit 1 <br /> 1. ii�� <br /> �L' 2. — tJ E? I w!-ec.�c`�2 it 2 <br /> a. '75 Fiz c/ .M N� m v� ff <br /> 4. <br /> �(] Unit3 <br /> 6. i0 Unita <br /> 7 <br /> 8. ❑Unit 5 <br /> 9. <br /> 1 D. <br /> Q Unit fi <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tiUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ��GISCLIDWASTEFACIrL�ITYNEHI IE//,, -- <br /> OTHERCLEANUPSRE(NON•LOP) ❑HOUSING ABATEMENT ,p WASTETIRE ,� ri' /V,-M � • <br /> ®UNDERGROUND TANK(MDNRORINGIREMDVALV— E]FOOD FACIL" C3 DAIRY �I-Z- Z7-13 <br /> ®ABOVEGROUND TANK L4- ❑CHICKEN RANCH/DOG KENNEL R WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIAL", ❑MOTELIHOTEL {❑�PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILRY oL �❑POOLISPA 1�LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING FE]7 COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw: M ONDAY-FRIDAY 8:00 AM-5:0OPM(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 feast one file type MUST be selected. Fax to(209)464-0738 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 EHO 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 fora 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-EHD USE ONLY <br /> d CVQ 4o h X 3 5 <br /> la- 3'3-(3'. 4Q � ai <br /> ❑ Reco ds pr_ouided-by-S -PP-R..Complete. StalfNamw <br /> Received T(me Dec, 4802 "° ' <br />