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<br /> 03/25/2013 09:39 FAX
<br /> w: EHD LOG NUMBER
<br /> DATEREcEIVE=D SAN'JOAQUIN COUNTY
<br /> zr� n ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 6232
<br /> 05
<br /> Stockton, CA 952 -
<br /> �+ a. 1868 East Hazelton Avenue, �.
<br /> r '1 1 phone: (209)468-3420 Fax: (209)464-0138 Web: Www.sjgov,or91ehd
<br /> ;A J 1
<br /> r',..t.F,,w-WUBLIC RECORDS RELEASE APPLICATION
<br /> l ;l�A� -p . , + BUSINESSIAGENCY: �Y� ���.5� IIS �U�
<br /> APPLICT: 1l(�� 4l�
<br /> ADDRESS: CITYISTATEIZIP: OQ ��I�
<br /> ��(6) S1 t} �{)r!> PHONE(2): LSio.3$ '�; V . FACSIMILE:
<br /> PHONE(1): �-- Zo 3 .- gee . Time: $=� a�rirt.
<br /> TEN 7►VE*APpOlNTMEN7 f7AT :.t:r `' {`ti` Yi
<br /> (Please allow 10 business this from date of appl anon sub -SS
<br /> -"Tentative only-must be confirmed]
<br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1
<br /> FEE ASH OZ�H!EEC!_K�101NLYY) �R—EQUEST PROCESSED IN 3 9USINEISS DAYS
<br /> DATE
<br /> SIGNATURE OF APPLICANT
<br /> Electronic Information: . .0 List❑ Map ,.Desci'ep on:
<br /> EHID USE ONLY
<br /> FILE ADDRESS
<br /> Street# Street Nam0 city ❑Unit i
<br /> in
<br /> Unit 2
<br /> 2. �}2 a �15q �rQ. �,SZ`� 3�2 G ❑
<br /> 423 Madison and 420 Madison'= C Un[t 3
<br /> 4. . Historic reports `. x �aero�" w .. ` ;
<br /> Any boring logs in the Files 27�'�ILS 42ep-0r1 d
<br /> s. Well installation reports - �- ] � �C " �;t 4
<br /> Soil investigation reports /
<br /> 7. . Groundwater investigation reports " - �'l ( ,
<br /> g, .' UST removal reports ❑unit 5
<br /> 8.
<br /> Groundwater monitoring reports
<br /> r rF11 Unit 6
<br /> 10.
<br /> _ , �-. � � rt- t4
<br /> Specific Date Stange of information Requested: From -
<br /> f ENVIRONMENTAL 14EALTH DEP RTMENT FILES
<br /> a SOLID WASTE FACILITYNEH ICLE
<br /> ®t1NDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MEbicAL WASTE FACILITY„, C7 ,
<br /> NousiNG ABATEMENT ❑WASTE TIRE
<br /> ®OTHER CLEANUP SITE(NoN-LOP) _. . DAIRY
<br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) EI FOOD FACILITY
<br /> AI3OVEGRDUND TANK - • s. . -. E]CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT
<br /> ❑MOTELIHOTEL Q PUMPER TRUCKIYARDICHEMICALTOILETS
<br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS, . .' e- ;p LAND USE APPLICATION SITES
<br /> � � 0
<br /> []TIERED PERMITTED FACILITY ❑'COOLISPA"
<br /> []
<br /> OMpI.AiNTIRESPONSE RECORDS R OTHER(PLEASE SPEGIFY) "CW
<br /> TATTOOIBDDY PIERCING
<br /> WELL ANE]SEPTIC PERMIT ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY a:00 AM-5:00PM(EXCLUDING HOLIDAYS)
<br /> 1. Listu tote addresses in the'space above. Select the types)of foes 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 END.-Applications received after
<br /> 3:00 pm will be processed the next business day.' s
<br /> 2. The EHD will notithe applicant If any END files exist:An appointment for review'will be confirmed approximately ten
<br /> fy {10]
<br /> days after receipt of application.:The f!les will be field for a maximum of five business days for review. Appointments
<br /> should be scheduled accordingly. z,
<br /> 3. A file that is actively being worked on by END staff may notebe Immediately available for review. A new appNcation 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 thea cant.'
<br /> +'B_ Cl 1=L'fK A" h SE'O�ITL�.Ir;
<br /> Future file reviews by the sante applicant may require a$125 deposit prior to review. r N {t�
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<br /> Received Time Mar. 25.-
<br /> Y2013 9: 3bAM No. 2627 f
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