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04 2017 03:55PM Enviro Assess 8776235493 page 1 <br /> it EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> IF Naomi <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> N 0 5 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232ww <br /> '�'A Telephoner (209)466-3420 Fax: (209) 464-0136 Web: w .sjgov.orgIehd <br /> 151J9Rt3l+[ AE TAI..FI!!<M-TH � <br /> PF-Mu-)E..ES PUBLIC RECORDS RELEASE APPLICATION fl <br /> APPLICANT: Heather Gemmrig BUSINESSIAGENCY: EnvlroAssessmenAP <br /> ADDRESS: BO B09 1154 CITYISTATEIZIP: Bormers Ferry,13131305 <br /> PHONE (1): 644-742-7311 PHONE(2): FACSIMILE: B�7-6 3-5493 <br /> TENTATIVE*APPOINTMENT GATE: Time: <br /> (Please allow 10 business days from date of application submittal-*TentaBve only-must be confled) <br /> L] CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH ORCHECK ONLY)-REQUEST PROCESSED IN 321[SINESS DAYS <br /> SIGNATURE OF APPLICANT Heather Gemmri <br /> 9 DATE Janu&' 04,2417 <br /> Electronic Information: ❑ List❑ Map—Description: s <br /> FILE ADDRESS EHD USE NLY <br /> [77r7O <br /> t#t Street Name City ❑ unit 1 t <br /> 7 South Jack Tone Road S#c�ckton �lR l�/ -_ P/ WIT <br /> ' 5(unit2 <br /> 3• 99 i <br /> 4. I?yw nit 3 <br /> 5. <br /> 6, GUp UST <br /> ®l <br /> 7. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10 �st iflt'ft+iDr <br /> I�rs1L.Ti <br /> Specific Dais Range of Information Requested, From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑e UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) Q MEDICAL WASTE FACILITY SOLD WASTE FACILITYNEHICLE <br /> 0 OTHER CLEANUP SITE(NCN-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> Q UNDERGROUND TANK(MONITORINGIRENQVAL) ❑FOOD FACILITY ❑DAIRY <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER T,I�R•EATMENT PLANT <br /> ❑Q HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCIf� RDICHEMICAL TOILETS <br /> Z TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINTI RESPONSE RECORDS ❑OTHER(PLEAsl�SPECIFY) <br /> WELL AND SEPTIC:PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5.00PM(EX..LUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking he appropriate <br /> boxes), At least one file type MUST be selected. Fax to 249 464-0138 or mail to the address indicate above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applicatio, s received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHE)will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximabely ten(10) <br /> days after receipt of application. The tiles will be held for a maximum of five business days for review,44l'f'AppointlllenCs <br /> should be scheduled accordingly. I! <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A newlapplication may be <br /> submitbed 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 pf the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> u <br /> IF <br /> F. <br /> 77- <br /> s , <br /> - <br /> ' 1 <br /> LI Iwwtar�lt'ornd by StfF= PRcalefe Ill = r <br /> EHD 4B-06 ,. <br /> .. — ...r,. :...,.:. <br /> 9l4/S2 <br /> Received Time Jan. 4. 2017 4; 54PM No- 0599 <br />