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Paul Humphre ,REA,CAC 559-226-3408 ! <br /> TN /7 <br /> DATE RE I k.EH*L'G NUMBU, <br /> I SAN JOAQUIN COUNTY <br /> 41oll ENVIRONMENTAL HEALTH DEPARTMENT ( ,n <br /> AF® 0� 1868 East Hazelton Avenue, Stockton, CA 95205-5232 <br /> ' �i�eIep one: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 9 <br /> 9�i ssF9�,y PUBLIC RECORDS RELEASE APPLICATION �2 / <br /> APPLICANT: PuLk't BUSINESS/AGENCY: <br /> ADDRESS: 7q!7 Z G, A t/L CITY/STATE/ZIP:.F2s,,ro c�4 '1373' <br /> PHONE (1): 581 177- 1813 PHONE (2): FACSIMILE:_ ZZ(.-�7yO6 <br /> TENTAT/VE*AP POINTMENT DATE: Time: <br /> (Please allow 10 business days from date or application submittal•*Temative only must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$126 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Name City <br /> _I <br /> $ I{U <br /> J9P�wut� �o util E] Unit 1�- (,q i 9 <br /> 1` nt t�Dc* M <br /> 3, n <br /> 0 s LaJc Gk'{U f�PGun1}3 o s ❑Unit2 <br /> d 1 t 1//! NoPJ n <br /> ' D <br /> 5 �— p Unft3 1 <br /> (1_'xei'1� � <br /> (2'tJnit 4 <br /> pus r)o cosp u�i3 <br /> un11- <br /> � ours 3 0 Units <br /> 9. <br /> 10. <br /> Specific Date Range of information Requested: ❑Unit 6 <br /> From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES. <br /> ®UNDERGROUND TANK UST CLEANUP SITE LOP �^'.. e� <br /> (UST) (LOP) ❑MEDICAL WASTE FACILITY �Y' <br /> ®OTHER CLEANUP SITE(NON.LOP) ❑HOUSINGABATEMENT ❑WASTE IRE FACIUTYNEHICLE 3 <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑WASTE TIRE �N <br /> ®ABOVEGROUND TANK C1 DAIRY <br /> CHICKEN RANCH/DOG KENNEL29 ❑WASTEWATER TREATMENT PLANT N <br /> HAZARDOUS WASTEIHAZAROOU5MATERlALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑PDOLISPA <br /> E]TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HO LIDAYs) <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 indioafed above Address <br /> ranges will not be accepted -for addltlona[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 Hiles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The riles will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A filethat 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$126 deposit prior to review. "BOXED AREA-EHD USE ONLY <br /> nprovided <br /> 15 OW 1�. <br /> 1:3 taff-PPR Complete. Staff Name: <br /> F7in"-DR <br /> Received Time Nov, 8. 2013 11 :30AM No. 4477 9412 <br />