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DATE[iECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY �V <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> r� 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:wu w.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Curtis Payton BUSINESS/AGENCY: ERAS Environmental <br /> ADDRESS: 121735 Street CITY/STATE/ZIP: Sacramento,CA 95816 <br /> PHONE(1): 916-267-1246 PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> _ (Please allow 10 business days from date of application submittal--Tentative only-must be confirmed) <br /> ©CHECK BOX TO EXPEDITE REQUES125 EE( SHO C E K ONLY -REQUEST PROCESSED.IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 15 May 2013 <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City i <br /> 1. 2735 Teepee Drive Stocktonby r /f <br /> 1 2. 2826 Teepee Drive Stockton ) C ❑Unit 2 <br /> 4. <br /> Unita <br /> 5 <br /> 6. <br /> ❑dnit4 <br /> 7. <br /> a. <br /> ❑Unit 5 <br /> 9. <br /> 10, <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICALWASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE Z <br /> ®OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑WASTETIRE C b l ,l b.A 1 13 <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY O <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL El WASTEWATER TREATM P iL A t� I <br /> ®HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MoTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETs <br /> ❑TIERED PERMITTED FACILITY ❑POOIJSPA ❑LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING ❑COMPLAINTIRESpONSE RECORDS ❑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 typa(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 theapplicant <br /> Future file reviews bythe same applicant may require a$125 deposit prior to review. - BOXED AREA=EHD USE ONL <br /> P;C <br /> oL IJ INAlp, <br /> ❑ Records provided by Staff-PPR Complete.staff Name: <br /> EHD 48-06 916112 <br />