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\�Paull Humphrey, REA, CAC 559-226-3408 p.1 <br /> D PEI <br /> EIV <br /> ED EHD LOG NUMBERSAN JOAQUIN COUNTY /� <br /> Ab 30 20,17 ENVIRONMENTAL HEALTH DEPARTMENT �70oo <br /> • � 1868 East Hazelton Avenue, Stockton, CA 95205-6232 VV <br /> t.R " <br /> ep one: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgc)v.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Re, tJ �4 t­,," P�ce4 BUSINESSIAGENCY: <br /> ADDRESS: '74o2- L • �(CI1,4)4- Ave-Awe CITYISTATE/ZIP: Y(' &--ty' 64 83-737 <br /> PHONE (1): D s9 �77- ! �I3 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 REQUEST;,-,y5 FEE(CASH O HECK NLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t�� 1LO017 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> _W15IW9(I. _C LiA, HM/HN <br /> 2. <br /> MAST <br /> 3. � � CupA-UST <br /> 4. 1 Pf d <br /> 7. papa ow'ta <br /> s. d <br /> 9. �j�5�1� w� t�2&AA!5 <br /> 10. --- I LD N vVl <br /> Specific Date Range of Information Requested. From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> ��77ff'vF1O'''THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT �WASTE TIRE <br /> 29-UNDERGROUND TASK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> E5A60VEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL 'WASTEWATER TREATMENT PLANT <br /> 4 HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> R TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATPODIBODY PIERCING ❑COMPLAINT/RESPONSE 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 types)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 /> 4�llc�t - `/ fctt;o :,,ler 41,_- t C(, "91IAn 1,e- rt , . 0011A <br /> ❑ Records provided by Staff•PPR Comnletp_Staff Name: <br /> Received Time-Aug. 29, -2011- 5:49PM-No. 2190 °I�,z <br />