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--A—Rk�M:N5'ZW�-� a�. Z7-.-�l— • <br /> --------- - .... ---------------------- <br /> Paul Humphrey, RL-, CAC p.1 <br /> ■ <br /> ■ <br /> ■ <br /> TE RECEIVED --:HD LOG NUVE3E <br /> SAN JOAQUIN COUNTY <br /> Lj <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> DEC 19 2013 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.oVehd'-, <br /> ENVIRONMENTAL HEAUff-I ny <br /> PE- ES PUBLIC RECORDS RELEASE APPLICATION F I L <br /> APPLICANT: D h!]�� BUSINESS/AGENCY: <br /> ADDRESS- (I-f ;-t-4-o', CITY/STATEIZIP: Fre 0--j 737 <br /> -7 PHONE (2): FACSIMILE: <br /> PHONE(1): -q913 :3S'Q 2z-6-3Vb8 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> F1 CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Infomation: L] List Ej Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street#—I Street Name City 0 Unit I <br /> 3. J <br /> — a <br /> 4. 1--- <br /> -U Unit 3 <br /> 5. <br /> 6. <br /> �E]Unit 4 <br /> 7- <br /> ❑Unit 5 <br /> ❑units <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 �j U–, <br /> OTHER CLEANUP SITE(NON-LOP) 0 HOUSING ABATEMENT ,BWAsTETIRE <br /> P9 UNDERGROUND TANK(MomrYoRiNGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> R ABOVEGROUND TANK ❑CHICKEN RANCH!DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑IMOTELIHOTEL ❑PUMPER TRUCK[YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑PODLISPA ;91 LAND USE APPLICATION SITES <br /> ❑TATTOOISODY PIERCING COMPLAINTIRESPONSE RECORDS [:]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RmEw: MONDAY-FRIDAY 8:00 Am-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Selectthe 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)4640138 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. Anew application maybe <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 /> 0 Records provided-by-Staff-PPR-C�qm plete. Staff Name: <br /> n I Ti' n 1n r)A 1 1) 1, i')num Ann ) <br />