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Paul Humphrey, R#, CAC 526-3408 p.1 l tV EHD LOG NUMBER IVED AN JOAUINOUNTY ENvIRENTAL HEALTH E . ' DEC 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232, Telephone: (209) 468-3420 Fax: (209) 464-0138 Weis: www.sjgov.org/ehd ENVIRONMENTAL HEALTH PEPUBLIC RECORDS RELEASEAPPLICATION APPLICANT: BUSINESS/AGENCY: ADDRESS: Z.. Q ' ; 2 CITY/STATEIZIP: Y+-13 I J PHONE (1): ' �� 7 lJ �3 PHONE (2): FACSIMILE: 531 TENTATIVE! APPOINTMENT DATE: , Time: (Please Allov) 10 business days from date of application submittal - °TerdaSve only - must be confirmed) El CHECK BOX TO EXPEDITE REQUEST - $925 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: [].List [I Map — Description: FILE ADDRESS EHD USE ONLY Specific Date Range of Information Requested; From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY 'AD SOLID WASTE FACILTTYNEHI LE 4 OTHER CLEANUP SITE (NoN-LAP) F1HOUSING ABATEMENT ,'B WASTETIRE t ® UNDERGROUND TANK (MONIidRINGIREMOVAL ❑ FOOD FACILITY ❑ DAIRY r,,G) ,_ 7Z7-1,3 EIABOVEGROUND TANK. c,,4- [] CHICKEN RANCH! DOG KENNEL ,Q WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIAL ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHE=AL TOILETS TIEREDPE-mi TED FAOILRY ® POOLISPA ;0 LAND USEAPPLICATIDN SITES ❑ TATTODI(3oDY PIERCING JEJ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW: M ONDAY-FRIDAY 8:00 AM-5:00pm (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one fie type MUST be selected. Fax to (209) 46"138 or mail to the address indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed approximately ten (1 A) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned: in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $126 deposit prior to review. —BOXED AREA:-; EHD USE ONLY L 3 Reco ds provided=by--B-PPR..C_bmptete- sia Name: Received T(me Dec:18._2013—_ 6 13PFAo.4802 914112 M Street # Street Name City Q Unit 9 l� ., ML me— �) tau %'eck ,t _ Z 2• 3. O �J� �I] Unit 3 4• . 5- ,E Unit4 S- 7- ❑ Unit 5 8. 9. Er Unit 6 Specific Date Range of Information Requested; From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY 'AD SOLID WASTE FACILTTYNEHI LE 4 OTHER CLEANUP SITE (NoN-LAP) F1HOUSING ABATEMENT ,'B WASTETIRE t ® UNDERGROUND TANK (MONIidRINGIREMOVAL ❑ FOOD FACILITY ❑ DAIRY r,,G) ,_ 7Z7-1,3 EIABOVEGROUND TANK. c,,4- [] CHICKEN RANCH! DOG KENNEL ,Q WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIAL ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHE=AL TOILETS TIEREDPE-mi TED FAOILRY ® POOLISPA ;0 LAND USEAPPLICATIDN SITES ❑ TATTODI(3oDY PIERCING JEJ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW: M ONDAY-FRIDAY 8:00 AM-5:00pm (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one fie type MUST be selected. Fax to (209) 46"138 or mail to the address indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed approximately ten (1 A) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned: in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $126 deposit prior to review. —BOXED AREA:-; EHD USE ONLY L 3 Reco ds provided=by--B-PPR..C_bmptete- sia Name: Received T(me Dec:18._2013—_ 6 13PFAo.4802 914112 M