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V03/25/2013 09:39 FAX Lo 001 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .1 r 'r !pphone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> �,yNi-vPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: IA4\1 NO BUSINESSIAGENCY: T,(ed4VYfl19-P1i0j611AW0q4fN <br /> ADDRESS: s6) 1 q W&�I '?i ��W( .__ CITY/STATEIZIP: 00-WA ,(if 9W11 <br /> PHONE(I)- ('1O) 914 -_704-� PHONE (2): L516)391 FACSIMILE: <br /> TjvE-APPOINTMENT DATE: 2o/3Time: 9:/5 qlnlL <br /> (Please allow 10 business days from date of appli6ation submittal-*Tentative only-Must be confirmed) <br /> F]CHECK BOX TO EXPEDITE REQUEST-$1 FEE ASH O HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE N2-d]13 <br /> f <br /> Electronic Information, El List El Man-tescriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city [I Unit I <br /> 1. 420 <br /> oc"y Y) <br /> 2. j 21� N. M,M'i on El Unit <br /> 3. 423 Madison and 420 Madison' Zv o0,141/1A V 1 <br /> 0 fli <br /> 4. 0 Historic reports P-06104IT8 L/y2X') '0Unit 3 <br /> 06F, xili� <br /> 5. o' Any boring logs in the files _0119" C <br /> 0 Well installation reports PAR 4 ( ) <br /> 6ql,;. C <br /> 0 Soil investigation reports �I-e- <br /> , <br /> 10.I7. a Groundwater investigation reports 'jm ) LiN 12 0 Unit 5 <br /> 8. 0 UST removal reports <br /> 9. 0 Groundwater monitoring reports <br /> [I Unit 6 <br /> IL <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY E]SOLID WASTE FACOMfVEHICLE <br /> OTHER CLEANUP SITE(Mom-LOP) ❑HOUSING ABATEMENT [j WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND,TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS E]MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY [❑I POOLISPA ❑LAND USE APPLICATION SITES <br /> Fl TATroo/BoDy PIERCING [j COMPLAINTIRESPONSE RECORDS MOTHER(PLEASE SPECIFY) "CW <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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-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(110) <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 be <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. <br /> 0.� <br /> .......... <br /> L <br /> ------------j------ <br /> N, <br /> ­6"d' <br /> .Ei ;Stafi'tPI't <br /> W4112 <br /> Received Time Mar. 25. 2013 9:36AM No. 2627 <br />