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10/13/2015 13:24 209-736-4730 COPY CENTER PAGE 01/01 <br /> ® G <br /> to <br /> � IF <br /> h <br /> a <br /> 13 DATE RECEIVED SAN JOAQ6JlF! COUNTY EHD LOG NUMBER <br /> 3 is RECEIVED <br /> EN111ONMENTAL HEALTH DEPARTMENT <br /> OCT � � 2Qf5 1868 East Hazeftart Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:wunw.sjgov,orglehd <br /> ENVIRONMENTALHE=(ALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PEHMlT18hKUU0= <br /> k "` 1t a <br /> APPLICANT; Ion Q. c �e Y1 e,�" r� Bl9SIFFES3/AGENCY:. �e."l <br /> ADDRESS: 2 2 1 �jw' S S( I .G-- CITY/STATEOP: Lppli CA <br /> PHONE(1): 2-0-1`10 -0-711 'PHONE(2): FACSIMILE: <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 /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR <br /> f1CHECK ONLY)-REQUEST PROCESSEU IN 3 BUSINESS DAYS <br /> SFOfU.5rAf3LFCAiTAIR <br /> DATE 10 - 12-^ 1S <br /> Elscfronlc Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> SEmet a Street Nacna city EHD USE ONLY <br /> 1. 12� 5 I N. Ik0rn+0y1 1_0 d i Iv9 N�., ,1t-�1 rp 7- n caps <br /> 2 1350 I N . Thacn+on R.ct , EC) cA i NfF _ until <br /> 3. T1393 CD N . ThoM'�On P.ct- L 1 Pki <br /> � ^ WVnitz <br /> J 4. ll 2.S 50 N . -71tior,(\+o•n 12-8. L c� I II2€t <br /> 5. 123`10 N . `Thos r�� ars )2_d. Lod% IC/2l <br /> </ s. fl $S N. (horn �ay� Rd L-0 ejnn37• �'t Sc� I NII1ar� brnR1 fnn4 <br /> 8• I' 14(s�`( N_ i tn.p� bpr 12 c1 Lb d t0 SITE MITIGATION <br /> s• I (,0 5 N , o n 2d_ ('C)C4 i <br /> jV, v K 'CO C I,Cw -to nu s <br /> 6136dNC Data Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNmRDROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WAsrE FACTUTy <br /> Ll OTHER CLEANUP SITE"LOP) ❑HOUSING ABATEMENT ❑ IRE FACRfSYIVEHICLE <br /> [71 UNDERGROUND TANK DNnORR/GIREMOVAL ElWWASTE TIRE TIRE <br /> (Fd ) ❑F000 FAcfLRY ❑DAIRY <br /> ❑ABOvsoR0uND TANK ❑CHICKEN RANCH/DOG I-NNEL []WAMVATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRucK1YARWCHENEcAL ToiLErs <br /> ❑TEREED PEE RM1l lED FAriLri i ❑PDDLISPA ❑LAND USE APPLIcAnm SITES <br /> ❑TATrODIBODY PIERCWG ❑COMPLANTIRMPONsE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERWT RECORDS ARE AVAILABLE FOR REmEw; MONDAY-FRIDAY 8;06 AKi-5:00PM(EXCLUDING HOLIDAY$) <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 Elie type MUST be selected. Fax to(2081464.01$@ ormall 1 M fhe 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 EHD at the number noted above. <br /> 3. The EHD will notify the apptl¢ant if any 6HD files exist. An appointment for review will be confirmed approximately ten(1 D) <br /> days after receipt of application. 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 m the expense of the applicant <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. "`°BOXED AREA-EHD U$E ONLY"' <br /> v � . 11�- <br /> R Complete. <br /> o StoottriName;o'% 1 c L yaeo� NwwA JCJ{'tie �6 r6 IgF �vi c2�. <br /> Records provided byy Staff-PP <br /> eNOuas 711115 <br /> Received Time Oct, 13. 2015 1 , 23PM No. 9777 <br />