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03/25/2013 09:39 FAX 10001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 B68 East Hazelton Avenue, Stockton, CA 95205-6232 (Y�, <br /> @4AP 2 2 gllvephort (209)468-3420 Fax: (209)464-0138 Web: vvvvw.sjgov.org/ehd <br /> ;-,=AOPUBLIC RECORDS RELEASE APPLICATION <br /> ' �� td1Tt13�NziIL;y <br /> APPLIC T) : BUSINESSIAGENCY: T)iZ4 .VO11 9-9ft q LfgVIQQQ <br /> ADDRESS: 561 1 �1j'Qe� I 'JjY FIUpY CITY/STATE/ZIP: NY-WA ,CF) I' yl/ <br /> PHONE(1): 6) PHONE(2): (51n 38 "9,j1T' FACSIMILE: <br /> TEN TIVE*APPOINTMENTDATE: dei l ift, 20/3 Time: 9:l5pwt, <br /> (Please allow 10 business days from date of appil6ation submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1A FEE ASH O HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ' 12g'1r 3 _ <br /> '1 <br /> it Electronic Information: ❑ List❑ Map Descript on: <br /> J FILE ADDRESS . EHD USE ONLY <br /> �l 1 Street# Street Name city Unit 1 <br /> [4. <br /> 20 N. Mai ai S eek- � un-j2 . Ma ISO C0 G ✓j u tl°v /7P ElUnit 2 <br /> 423 Madison and 420 Madison <br /> . Historic reports ita. • Any boring logs in the files <br /> 6 . Well installation reports JI/ \ <br /> Soil investigation reports04111"t a (Ile <br /> 7. • Groundwater investigation reports <br /> 8. . UST removal reports ❑Units <br /> g_ • Groundwater monitoring reports <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From EQfI1P.S to 2005 <br /> ENVIRONMENTAL HEALTH DEP RTMENA T FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEHI E n <br /> ®OTHER CLEANUP SITE(NON-LOP) - ❑HOUSING ABATEMENT ❑WASTE TBtE y 122� <br /> ®UNDERGROUND TAN K(MONITORINGIREMOVAL� ❑FOOD FACILITY ❑DAIRY <br /> ^J <br /> ABOVEGROUND TANK 11 ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUSWASTEIHAZARDOUSMATERIALSV- ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETs <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITEES,v, "� <br /> F1TATTOOIBODY PIERCING [-]COMPLAINTIRESPONSE RECORDS t4 OTHER(PLEASE SPECIFY) "Cilllk. <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> -- -1. List up toten-addresses-in-the-space above. Select the of-files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail to the address indicated above_ Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may he <br /> submitted when the file Is available. <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. **'BQXED ARE'A:;uEHTS USB dNLI? <br /> f �. 1�/ii � -i-: ,iy� r� a!{I I i I ,� i il'�• l��.l ll C-,Y i i iU E,i r i �1 >r S �r 'i ;A , irK r.i x, i i i 1.., I � <br /> -a P",l r ,I TY t fi di+ r Iri�l x( t9 in 4-,' Ir ,tvp � <br /> 4. <br /> 1F <br /> ru, = k,i"1 " FI,. <br /> f.' 14 dlbilHr ill�il i�":r ��r r4 .i;�t, 131 Jf(ll li^� I�I�ri�� ii".104: .,i�, �.I i�i'I ,',i ��i Pl rf:ry It�411111�1i Ir bill <br /> y r _ r� f� e 1 i n I @0 <br /> [],IjecUhdS prov(r)er1 b�5t;� PPR Cioptplea(aff,Name �� �,,,t„ It <br /> Received Time Ma r. 25. 2013 9:36AM No. 2627 �° <br />