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Paul Humphrey, REA,CAC <br /> 5F9-226-3408,.- p,1 r <br /> 1. <br /> DATE REC$Ak, 0 # <br /> EHD LOG NUM ER <br /> 1. ( � SAN JOAQUIN COUNTY } <br /> 0� A ENVIRONMENTAL HEALTH DEPARTMENT' <br /> �i 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> of®r� "gelepFione: (209) 468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> sF9�t11 PUBLIC RECORDS RELEASE APPLICit <br /> ATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 71127— ✓= /;,y I aN A of CITY/STATE/ZIP: <br /> PHONE(1): q1417 7- j e FACSIMILE:PHONE (2): —F2L : C/+ZZe- ?83 <br /> TENTATIVE*APPOINTMENT DATE: �Y06 <br /> (Please allow 10 business days from date of application submittal••Tentative onl Time: <br /> y-.must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> f <br /> FILE ADDRESS EHD USE ONLY Street# ,_ Street ame City <br /> �y 1. $ i{ ( qNKd_ 7 OG�C�Oy� dA�iwut� NccosPunzl3 ❑Unit l <br /> 2. M <br /> 3 d S `A 1`1S GlG'ffJ n�POun�}3 0 ❑unit e <br /> o <br /> 4, S <br /> "f I l/�lvl�n <br /> v )� <br /> Unit3 <br /> L= <br /> ( 1 <br /> T © pus Aocos�p�it3 <br /> 8. <br /> 9. NPP uAAI c os 3 ❑ Units <br /> 10. � <br /> Specific Date Range of informationRequested: From 171Unit e <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> ®OTHUNOER CLEANUP SITE <br /> (UST)CLEANUP SITE(LOP) ❑MEOICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> ®UNDERGROUND TANK(MCNIrORING/REMOVAL) [I FOOD FACILITY E:1 DAIRY (6'1 <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS C MOTEIIHOTEL ❑PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY 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 un to ten addresses in the space above. Selectthe types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)494-0138 or mail to the address indicated above Address <br /> ranges will not he accepted-for additions[assistance with file addresses, contact the EHD. Applications received after <br /> ' 3:110 pm will 6e processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for revlew 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 rile Is available, <br /> 4. Any file not returned in the same condition as released ill 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 ONLY <br /> 11-I�� ' <br /> t 6 <br /> v 2 Ik o <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Fun ea-m <br /> Received Time Nov. 8. 2013 11 :30AM No. 4477 914112 <br />