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Paul Humphrey, REA,CAC 559-226-3408 p.1 <br /> SAN JOA EHD LOG NUMBER <br /> UIN COUNTY <br /> � Q <br /> MAY 24 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 1 ' <br /> ENVIRONMENT <br /> ALHF AITMephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org(ehd <br /> PEM,-,i T jcERVIGES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: LA Y%A ,^ �t ,�y BUSINESSIAGENCY: <br /> ADDRESS: y J51 CITY/STATEIZIP: <br /> PHONE (1): PHONE(2): FACSIMILE: <br /> 5`i <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> [:] CHECK SOX TO EXPEDITE REQUEST-$125 FEE(CAS OR CCK ONLY)-REQUEST PROCESSED IN 3 BUS INES DAYS <br /> SIGNATURE OF APPLICANT �� G/ DATE j <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Name City ❑ Uni 1 <br /> )l<( <br /> 1!5j '2_ w e sb imn r <br /> ' ❑ Unit 2 <br /> 3. <br /> 4. <br /> Unit 3 <br /> fj/ <br /> 6. Unit 4 <br /> 7. <br /> B. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From I Ze o S to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JK UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> �C.OTHER CLEANUP SITE(NON- SOLID WASTE FACILITYNEHI E /I n <br /> ( ) ❑HOUSING ABATEMENT ❑WASTE TIRE"7 � (�j'U.�r I <br /> IS UNDERGROUND TANK(MONITORINGIREMOVAL. El Fool: ( <br /> FACILITY ❑DAIRY 1 <br /> ABOVEGROUND TANK pZ_ ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> �C]HAZARDOUS WASTEIHAZARDOUS MATERIAL�� ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ®,TIERED PERMITTED FACILITY ❑PDOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ <br /> TATTOO/BODY PIERCING ®COMPLAINT/RESPONSE RECORDS E]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. *°BOXED AREA-EHD USE ONLY <br /> L2 0 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time—May, 24. -2013-11 : 24AM—No. 3183 �a,Z <br />