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From:Terracon 916 856 8277 08/26/2013 11:19 #093 P.001/001 I ■ ■ I ■ ■ j ■RE GREN �® END LOG NUMBER ■ SAN JOAQUIN COUNTY AUG 2 6 2013 ENVIRONMENTAL HEALTH DEPARTMENT wk 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ENVIRONMENTAL HEALTH PERMMSEFMCES PUBLIC RECORDS RELEASE APPLICATION APPLICANT:BUSINESS/AGENCY: ADDRESS: �1L/b �� ..a�n �2e 76) CITY/STATE/ZIP: �o.-,-/ova PHONE (1): CQ/Ci gS8 -/ 5 J 9 PHONE (2): FACSIMILE: C�/G) BS13- BZ TENTATIVE' APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) V ev Yt ❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List ❑ Map - Description: FILE ADDRESS EHD USE ONLY Unit 1 'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Street # Street Name City - - 1. � C �_ Fg�l F�-��i L-o•�•a i �-�vr /� M ; .�tJ;jCL47, U i Unit 2 2. 3 702- _ _._ �4..+... a� L a,+ o— iC �o rJ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ TATTOOIBODY PIERCING OtVli :5 ol!�e EI'U nit 3 4. 7/�, La✓c - 5. ,//a�,,.�� 'o-/�-✓_ 1 _Aiu [fid%� E Unit4 111 (Ie7 �i &J0 LCY` ✓ ❑ Uni 6. 36`1.5 L-oN -e 8. 3 5S��LF/�'r-'� i L-a•�+_� J� a �� J 9. 773a ❑ Unit 6 10. Specific Date Range of Information Requested: From ENVIRONMENTAL HEALTH DEPARTMENT FILES 'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT UNDERGROUND TANK (MONITORINGIREMOVAL) " ❑ FOOD FACILITY ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL HAZARDOUS WASTE/HAZARDOUS MATERIALS C- ❑ MOTELMOTEL TIERED PERMITTED FACILITY ❑ POOLISPA ❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS to 0 ❑ SOLID WASTE FACILI NEHIC / ❑ WASTE TIRE ) � `P_ t `� ! ❑ DAIRY ! --II- ❑ WASTEWATER TREATMENT PLANT ❑ PUMPER TRUCK/YARDICHEMICAL TOILETS ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -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 file type MUST be selected. Fax to (209) 464-0138 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 exist. An appointment for review will be confirmed approximately ten (10) 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 $125 deposit prior to review. —BOXED AREA - EHD USE ONLY""" M1111111,100411i 1111111111111 ' M111INFRAMPA! 111 awe,", M, gill -MM MA A N, I M, N 21 A • • • e • • •Ler,• ,- / L �, It/ - / II EHD 48-06 Received Time Aug, 26. 2013 11:13AM No. 3923 r� 814112