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DATE RECEIVED � �l1l, As— EHD LOG NUMBER <br /> F ) )I CN �4T`�^ SAN JOAQUIN COUNTY <br /> t'C- t/,' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ! Tele aaone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd n <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: James Helge BUSINESS/AGENCY: ENERCON Services <br /> ADDRESS: 13434 Marconi Ave Sacramento, CA 95821 CITY/STATE/ZIP: <br /> PHONE (1): 916-480-9228 1 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 BOX TO EXPEDITE REQUEST-$1?5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Sys Vi (n 3 DATE <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - Ll Unit 1 <br /> I. 1055 South Stockton Blvd Stockton <br /> 2. A Stockton Blvd Stockton 5T 5 C7-unit 2 <br /> 3. <br /> 4. lJ <br /> nit 3 <br /> 6. <br /> Unit4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 <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 FAC LI�vNEHI /, L Z <br /> OTHER CLEANUP SITE(NON-LOP) EI HOUSING ABATEMENT ❑WASTEI IPS I •/ <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK OU ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TR ANT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE 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(209)464-0138 or mail to the address indicated above. Address <br /> ranges will notbe 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 prior to review. "'BOXED AREA-EHD USE ONLJ <br /> -2 - 3'• 0000 0 I `-- 5 --- <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 9/4/12 <br />