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: 10 2018 11:57AM Company 5593745 1 1 <br /> a�• ECEIV�� <br /> :: SAN.--m OAQUIN <br /> jUIL 1 n Z01 Environmental Health Department <br /> -COUNTY PUBLI RECORDS RELEASE APPLICATION <br /> • G/ertn,ess groves he RONtdlENT1. �� n <br /> PEI1�Wff/SE� BY Ef+�All. 1 10 Iiq <br /> EHD LOG NUMBER: 0 <br /> APPLICANT: Paul Humphrey BUSINESS/AGENCY: <br /> ADDRESS: 7402 E. Clinton Ave CITY/STATE/ZIP:Fresno,CA 93737 <br /> PHONE(1): 559 977-9813 PHONE (2): FAX OR E-MAIL: paul@esahumphrey <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact yo arrange an poi Lint date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE July to,201e <br /> 1. List up to ten addresses in the space below. Add ss rang WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to!nLo@s*cehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> 3. 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 /> 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$152 deposit prior to review. I(� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) ll lift <br /> Electronic Information: ❑ List ❑ Map— Description: It <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS �C D 3 I3 I <br /> HEALTH DEPARTMENT , <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> �X Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) Q P-,�+�',I D —r <br /> V F ❑CONSUMER <br /> OtherCleanupSite(Non-LOPI`L t 11101 W� `T! W��A 1 T��cy �.�. IF <br /> ❑X Hazardous Waste DAIRY <br /> QX Tiered Permitted Facility 2 � Pa-i 'u's�''' P4*5G� ❑ <br /> FX Aboveground Tank 1 a S'r 4M, i ha t <br /> FX UST (Monitoring/Removal) 1 r v ❑PWS <br /> ❑X Hazardous Materials 3 <br /> FX Spill/Release Response <br /> QX Solid Waste Facility/Vehicle4 ©WATER QUALITY <br /> Food Facility <br /> ❑Pool/Spa SITE MITIGAT10H <br /> Dairy 5 <br /> FX Land Use Application Sher <br /> ❑Septic Pumper Truck/ 9 ❑HDUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant <br /> ❑Housing Abatement 7 Q'CUPAAST/HM/HW <br /> ❑Motel/Hotel <br /> Chicken Ranch/Dog Kernel ©cUPA <br /> Medical Wasta Facility 9 UST <br /> Tattoo/Body Piercing <br /> ❑Waste Tire rg SOLID WASTE <br /> 9 <br /> ❑Complaint <br /> []Other(Please Specify): <br /> CM]AccouNm iG <br /> 70 <br /> -BOXED AREA-EHD USE ONLY" <br /> I C <br /> 71131'Records <br /> .1 3 = O 0vi2(� ) <br /> a rye (n 1' 3 �K j�mvid / 11 r� tb Yrs provided by Staff-PPR Complete. Staff Name: EHD 48119 <br /> Re c e i v e d T i m e)id a 1. 10. A.0 18,o 11 : 5 0AN N-o. 3_847,205 i T 209 468-3420 1 F 209 464-0138 i www.sjcehd.com <br />