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®� Paul Humphrey, REA, CAC 559-226-3408 p.1 <br /> ■ <br /> MEREF07 VEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ■ <br /> AUS ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> IlONMEt, ,UALtr& gphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd <br /> PEINdfT/SERti1vE$ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��v�� nu MP_ (� y BUSINESS/AGENCY: �-rvund 2e,-D A-�y.)y <br /> ADDRESS: 7902- L• C.41 CITYISTATE(ZIP: F/Y_6 nyo C,+ q5'737 <br /> PHONE(1): 351 q77-96f3 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) /, r <br /> ❑ CHECK BOX TO EXPEDITE REQU -$125 FEE(CP9H OR C K ONLY)-REQUEST PROCESSED IN 3 BUST ESS DA S 41 <br /> SIGNATURE OF APPLICANT DATE S ZS 20j <br /> Electronic Information; ❑ List❑ Map-Descripti <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1. jitio mer- GkPA- Him/ <br /> 2. if ITIA . O, h ry ®' <br /> 3. 11 W It it it r. C tApA - `-AST <br /> 4. i 37T14 0 fn ROPLA <br /> 6. <br /> 7. <br /> 10. - I ' e , <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 /> OTHER CLEANUP S17E(NON-LOP) ❑HOUSING ABATEMENT ®WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DDG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> �S] HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY 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 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(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 the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit priorto review. "'BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Aug. 25. 2017 11 : 02AM No. 2158 <br />