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■ ■ <br />■■X AA1T!5-TVED J SAN OAQUIN COUNTY EHD LOG NUMBER <br />■:■ ENVIRONMENTAL HEALTH DEPARTMENT t <br />OCT 2 0 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232` ' <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web; www.sjgov.org/ehd <br />ENVIR03 IMENTA L HEALT' t <br />pFRMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br />S � <br />US <br />APPLICANT: Lita Freeman <br />ADDRESS: 1420 E Roseville Pkwy, #.140-262 <br />PHONE (1): 916677-9897 PHONE (2): <br />BUSINESS/AGENCY: ,ABI Consultants <br />CITY/STATE/ZIP: Roseville, C.A, 95661 <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. <br />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 10/10/1.4 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑unit 1 <br />Street# <br />Street Name city <br />�. <br />—Broadway <br />1. <br />191.9 <br />N_ Avenue s Stockton <br />tui <br />i Z <br />2. <br />1905 <br />N. Broadwa Avenu Stockton <br />3, <br />p -v It 3 <br />4. <br />p`Unit 4 <br />B. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />D-l"(nit 6 <br />10. <br />Specific Date Range of Information Roqueeted. From 1940 to present <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ® SOLID WASTE FACILIIT^YNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT j N� 160 Pr' <br />❑ WASTE TIRE � S, <br />© UNDERGROUND TANK (MONITORINWREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />I15Q MOVEGROLIND TANK ❑ CHICKF-N RAuCff( DOG KENNEL ❑ W.Asa NATER TF,EATMENT PLANTJ <br />® HAZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTEL(HOTEL ❑ PUMPER TRUCKIYARDICHEwCAI_ TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING M COMPLAINT/RESPONSE 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_ 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 END will notify the applicant if any EHD files exist. An appolntment 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 ralaaseq will be reorganized by EHD staff at the expense of the applicant_ <br />Future file reviews by the same applicant may require a $130 deposit prior to review, *"BOXED AREA - FHD USE ONLY""" <br />7777y, i te- Gbz! 3 <br />5 5 q :oa <br />,- <br />y 2 , .- G O's A11704d, <br />et�..sff Nanw s v-� <br />Received Time Oct, 20, 201 13 PM No. 366 (vr (COQ 'Dct, 1 } (Z -3_!u: 0,(DiA e cuPWI'4vif <br />Lk Py©4C er ,-Pfi Fp,. '0" 19!�f �"Wgay , (_� jl <br />