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( ENn I nC;NUMBER <br /> DATE RECEIVED • SAN JOAQUINCClv9Q� oN W 9M '6l 'aEW a�111 paniaaa� <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT kA <br /> 1868 East Hazelton Avenue. Stockton, CA 95205-6232 D <br /> MAR 2 9 201 <br /> � Ti elepltorte: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> E (��I[0�'L4 I`SV1R0NME1gTALHEALTI�i PUBLIC RECORDS RELEASE APPLICATION L l�U u <br /> � o <br /> APPLICANT, Leticia Martin BUSINESS/AGENCY: <br /> ADDRESS. 707 Wilshire Blvd. CITY/STAVE/ZIP: Los Angeles CA. 90017 <br /> PHONE (1): 323-605-6639 PHONE(2): 213-596-6175 FAX OR E-MAIL; Lmartin@k1cinf-elder., <br /> Please alloy✓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 /> ndM.I. - nip..•Ir^, ..,,,.-,.., .,,y,,.yr -I", ur.r.Mlnn.-•.r-�• __ i ..YI+_ ,.ax.-._.�,� Si i 71 <br /> rj if d� d30IO1dr,G EE,`i<'O�VWQl{E F� ESD:'�t� �US;RNts :. 1 ,.:.:�kpE• T <br /> SIGNATURE OF APPLICANT DATE lVl yrA, L01I7ol La <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EH®USI_ONLY <br /> Street 9 Street Name City <br /> F2. <br /> 4221 E. Mariposa Stockton <br /> nit 1 <br /> 3• 1 0Unit 2 <br /> 4. I t ❑unit 2H 4 <br /> 5. i t &'Unit 3 <br /> 6 Unit 3HM I <br /> ❑Unit 4 <br /> 8. SITE MITIGATION <br /> 9. <br /> p Runit 5 <br /> 19. 1 <br /> Specific Date Range of Information Requested: From <br /> id; f 1K�li6rIfii�'t;,; EAtq-CHI,pEpE :tt�;z. .t� , �f <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MOTELIMOTEL SOLID WASTE FACILITYNEHICLE Nt <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT []FOOD FACILITY <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) 0 WASTE TIRE ®DAIRY,P0011SPA <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL Q WASTEWATER TREATMENT PLANT <br /> [.IJ HAZARDOUS WASTE Q MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> Q HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> Q TIERED PERMITTED FACILITY ©COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 9. List up 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 1209?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 END 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$130 deposit prior to review, <br /> ***BOXED AREA-EHA USE ONLY— <br /> ■ <br /> 0 Records provided b_Staff-PPR Complete. staff Name: e® <br /> B® <br /> 1Z1-d 100/100-d 680-1 ZVZ61Z16V6+ a3013dN131N-woad wd9l Zl 9102-6Z-E0 ■� <br /> s ® <br />