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Paul Humphrey, REA. CAC 559-226-3408 p.1 <br /> CCEIVE? <br /> DRECENED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY 9,70oo <br /> kfi 30 A,17 $.� ENVIRONMENTAL HEALTH DEPARTMENT <br /> • EdlI� BONME1N;AL � 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Nk �1 �t `ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC (IRECORDS RELEASE APPLICATION <br /> APPLICANT: rG, LTJ ��t (� n�Y BUSINESS/AGENCY: <br /> ADDRESS: '7L1o2 ( Cti)4W Ove—V\ue CITYISTATEIZIP: ELL-&-Nv cA 83737 <br /> PHONE (1): S51 17 7-9 013 PHONE(2): FACSIMILE: <br /> TENTATil VE*APPOINTMENT DATE: Time: <br /> (Please allow f0 business days from date of application submittal-'Tendfive only <br /> CHECK -must be confirmed) <br /> ❑ BOX TO EXPEDITE REQUEST- 5 FEE(CASH O HECK NLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS ((�J <br /> SIGNATURE OF APPLICANT DATE 9/y912D,q <br /> Electronic Information: ❑ List ❑ Map—Description: IF <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City yen /1,a- <br /> 2. has f �fnd /'T�) �v //yyH�M� 7T <br /> rQ <br /> lit <br /> a. 'l-Al d <br /> 5rv wfy.tw.9 <br /> U AV e a ck4✓I �( <br /> f' 0 ) 1 d <br /> 9• _ lNaiu t� tj{y <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICL.E <br /> ��77ff'vO'''THER CLEANUP SITE(NON-LOP) [3 HOUSING ABATEMENT WASTE TIRE <br /> L7NDERGROUND TANK(MONITORING/REMOVAL) O FOOD FACILITY ❑DAIRY <br /> E5-ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL 'WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTVIRAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMFERTRUCKIYARDICHEMICALTDILETs <br /> IS TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTODIBODY PIERCING ❑COMPLAINTIRESPONSE 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 not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after <br /> 3:00 pre will be processed the next business day. <br /> 2. The END 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 priortoreview. —0BOXED AREA-EHD USE ONLY <br /> &- �II <br /> - C0. <br /> V� <br /> ❑ Records provided by Staff-PPR Comnlato- Staff Name C� <br /> Received Time—Aug. 29. -2011— 5:49PNrNo. 2190 9fOHt <br />