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From:Erik Brown Fax:(888)828-2636 To: 12094640138@rcfax.cc Fax: (208)464-0138 Page 2 of 2 0110412019 8:21 AM <br /> t4 <br /> SAN,,J04 <br /> OUORECEIVEDvironmenO 1-�iean Department <br /> sn mss~ r l_ JAN 0 4 2010 ,dUBLIC RECORDS RELEASE APPLICATION <br /> `. .. .. f,rrrzCnnsg yroer� !sere. f <br /> ENVIRONMENTAL H— EHD LOG NUMBER: <br /> SI <br /> APPLICANT: 'J., ,.._ ERVICES BUSINESS/AGENCY; 1F su I <br /> ADDRESS: 0 5 . .r- CITYISTATEIZIP: (''�aLYD.pr._± 0vl�vl A &' ''r <br /> PHONE(1): 'jZ6- 14'L g( U PHONE (2):Gj�_'�"� y " 'j' FAXORE-MAIL: a <br /> f eft& �'' M n ve+, <br /> r Please allow to business days Froin date of application submittal for the records to be available. <br /> Staff will confect you to arran n point t date and time to review the requested records, j <br /> SIGNATURE OF APPLICANT <br /> i. List uD to ten addresses in the s ace DATE <br /> list below b checking the appropriate P ddre es WILL NOT be accepted. Select the type(s)Of files rom the <br /> y g box(es). At least one file type MUST be selected. Fax to(209)46"138 mail to the <br /> address indicated below,or email to info(o)sicehd com Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 flies 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 $152 deposit prior to review. i/10 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ Last❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> NV <br /> EIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS a U5 i ylP.S .� ►-�(a <br /> FILES (Specific addresses only,address mnges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street$ <br /> Street Name City '•'b.f9 <br /> Cleanup Site(LOP) Vq /' I� e/�� � p � A <br /> (Other Cleanup Site(Non-LOP) 1 If 6- N, � :J Leer4 ❑Corvsunvr, <br /> Hazardous Waste t•�' -` S P 5 <br /> Tiered Permitted FacOky f V -f <br /> tl)D i" ❑DAII . <br /> MAbovegmund Tank `j Z'a, 11 e3'7 v - �0 a 9-1 Ca Gf� <br /> &tUST (MonitoringRemoval) �^ 69,rj AtD �(Gf r �PwS <br /> Ha_alloue Materials a �rj�/, lf6! '[r <br /> a th1CV. p <br /> '�-Spill/Release Response <br /> ¢'""� ND cO/�T <br /> ❑Solid Waste Facility/Vehicle 4 A.aa Ounutt <br /> ❑Food Facility <br /> ❑Pool I Spa <br /> ❑Dairy <br /> S ITe'MmcslloN <br /> I]Land Use Application Sites <br /> ❑Septic Pumper Truck/ —` - <br /> 6 ❑Ho slrvc <br /> Yam/Chemical Toilets <br /> ❑Wastewater Tmarrnent Plant <br /> ❑Housing Abatement 7 COPA <br /> ❑Motel/Hotel AST/HM/HW <br /> ❑Chicken Ranch/Dog Kennel <br /> ❑Medical Waste Facility a UPA <br /> F1TatTattoo/Body Piercing UST <br /> ❑Waste Tire a p souo WAsrE <br /> Complaint <br /> ❑Omer(Please Specify): <br /> 1a []ACCOVMINe <br /> 'BOXEO AREA-EHD USE ONLY'*" <br /> ir- <br /> 1-t - --Alla r 4-1a Ni 1! vv 1, <br /> I <br /> � r <br /> off Name: <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209468-34201 F .4164-020 13862�lc�d.corn MS <br /> Received Time—Jan. 4. _2018 8: 15AM No. 2817 <br />