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® Paul Humphrey, REA,CAC 559-226-3408 p.1 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAY 2 4 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, OA 95205-6232 <br /> E CNMENTALREALTRIephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ' <br /> PERVIV'i!CERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .al 14,%yn ,^It rt Y BUSINESS/AGENCY: <br /> ADDRESS: '2402- '[, C_t, o±cn CITY/STATEIZIP: }-/Yr,,5 Ylu CA '13-737 <br /> PHONE(1): 813 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 SOX TO EXPEDITE REQUEST-$125 FEE(CAS OR C. CK ONLY) REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT '� DATE � 2- y j <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1• E 51 'Z IBJ e �s t,.; �..,- cs�,t L:, � `� I Iu c <br /> J ' <br /> 7 2. ❑Unit 2 <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. i <br /> 6. <br /> ZUnIt4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> Unit S <br /> Specific Date Range of Information Requested: From ) Recc r S to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SRE(LOP) ❑MEDICAL WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHJ E <br /> ❑WASTE TIRE (�� E i ' <br /> UNDERGROUND TANK(MONITORINoIREMOVALV_ ❑FOOD FACILITY ❑DAIRY �i- _ <br /> ABOVEGROUND TANK pC_ E]CHICKEN RANCH!DOG KENNEL E]WASTEWATER TREATMENT PLANT] <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/.CHEMICAL TOILETS <br /> ®,TIERED PERMITTED FACILrx,<_ ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> [I TATTOOIBODY PIERCING ®COMPLAINTIRESPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTICE.PERMIT RECORDS ARE AVAILABLE FOR REViEw: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. _List uo 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 (1D) <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 rile 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 /> -( e <br /> E3 Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time—May. 24. -2013-11 :24AM—No. 3183 914/12 <br />