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LRose lAireles Fax (626) 346-7788 To: 2094640138Ldrefax con Fax: (209) 464-0138 Page 1 of 1 071132018 11:15AM <br />ORECEDGEI D., EHD LOG NUMBER <br />�Ir C SAN .10AQUIN COUNTY <br />MEN 9"J" M ENVIRONMENTAL HEALTH DEPARTMENT <br />OWNJUL 13 2018 "-1314 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd '1191 <br />�'�tYIIbDNlAFkiTAL F1�.7t1 <br />PERMff/S1s 8 PUBLIC RECORDS RELEASE APPLICATION <br />r <br />L <br />APPLICANT: Fulcrum Resources Enviromental <br />ADDRESS: 517 S Ivy Ave <br />PHONE (1): 800-385-7105 PHONE (2): <br />BUSINESS/AGENCY: <br />CITY/STATE2IP: Monrovia, CA 91016 <br />FACSIMILE: <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. j <br />7 �3 <br />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT /&4-0- 7ezl� DATE 7/13/18 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS1Cp-f <br />Street Name City <br />West LaneStockton <br />If, 1 USE ONLY;a,t^ _I-krnM <br />t�J1 <br />-Co.' <br />1 <br />Street # <br />3900 <br />NO cAp CON. NP DIPS - <br />.3. t 1Yf wJi <br />2. <br />3. <br />4. <br />5. <br />SITE MITIGATION <br />6. <br />7. <br />8. <br />9. <br />10. <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 FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ® COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List u p to ten addresses In the space above. Select the type(s) of flies from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0136 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 ONLY*** <br />Dcf'/fz�_ HYY)— <'r�l file <br />/)?II 071417 /1 /ln IRiU/n /1Mn "U !vi rlon 1) /—,1— /Clfv.. ., _ ,Nil <br />II ❑ Records provided by Staff -PPR Complete. Staff Name: ,A;,,n A ffl II <br />eceived Time Jul. 13. 2018 11:07AM No -3863 <br />