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M <br /> DATE RECEIVED n I nr. NIJIVIRPER <br /> SAN JOAQUIN CCL�?O."N N16 9 R -H pOw 1,1 P A I <br /> 9 <br /> 0- <br /> GD ENVIRONMENTAL HEALTH DEPARTMENT Ok e 1- <br /> RE r_IV <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> MAR 2 9 2016 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web, www,sjgov.org/ehd <br /> '--.-'---NV1R0NMENTALHFATtj PUBLIC RECORDS RELEASE APPLICATION <br /> ",I UF'T4-r ra Ea. <br /> APPLECANT., Leticia Martin SUSINESS/AGENCY, 10_I5'1nkUtX <br /> ADDRESS., 707 Wilshire Blvd. CITYISTATE/ZIP:- Los Angeles CA. 90017 <br /> PHONE (i), 323-605-6639 - PHONE(2): 213-596-6175 FAXORE-MAIL: LmartinOkleinfe1dmr.t <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 /> JT Ed 14Y P,; S. D.,N'.A: 'PRIME........... <br /> SIGNATURE OF APPLICANT DATE tV6✓r�.. Lqj'701 (-o <br /> Information: 0 List Ej Map-Descriptiom. <br /> FILE ADDRESS <br /> EH0 USI;ONLY <br /> Street 9 Street Ham@ city <br /> 1' 4221 E. Mariposa Stockton <br /> 2. S4 Unit 1 <br /> 3. n nIt 2 <br /> j <br /> 4. 0 unit 2H_ <br /> Y/Unit.3 <br /> Unit 3HM <br /> 7. EJ Unit 4 <br /> 'SITE MITIGATION <br /> 9. <br /> UR/Unit 5 <br /> Sp9c1fic Data Range of Information Requested: From to <br /> NTi'F L 9 3 <br /> f7l UNDERGROUND TANK(UST)CLEANUP SITE(LOP) SOLID WASTE FACIL17YNEHICLE IVg 5p,,' <br /> 2 OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT FOOD FACILITY <br /> 7 UNDERGROUND T ANK(MONITORING/REMOVAL) 2]WASTE TIRE 21 DAIRY,POOLISPA eA 4, <br /> 7 ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL 2 WASTEWATER TREATMENT PLANT ge5 <br /> W <br /> HAZARDOUS WASTE d MEDICAL WASTE FACILITY 0 PUMPER TRUCKIYARL)/CHEMICALToILETS <br /> A <br /> 7,/ HAZARDOUS MATERIALS El TATToomor)y PiERciiqG USE LAND "-'PPUCATION SITES <br /> 7 TIERED PERMITTED FACILITY COMFLAiNTIREsPONSERECORI)S OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RFvim MONDAY-FRIDAY 8:00Am.5:00Fm(EXCLUDING HOLIDAYS) <br /> 1. List UR 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(209)464-0138 or mail to the address indicated above. Address; <br /> ranges will not be accepted.Applications receiyed 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 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (110) <br /> days after receipt ofapplication. The files will be hold 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-E USE ONLY-- <br /> M Records provided by Staff-PPR Complete. Staff Nzinia: <br />