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DATE RECEIVED Z�?0-'°N Wdbl :d[ 9l 6 '66 'IPWE aUJIJ PaAI ;3;a <br /> SAN .IOAQUIN CG..,. <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 2 9 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ohd <br /> ONVIRONMENTALHEALTHPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Leticia Martin BUSINESSIAGENCY: <br /> ADDRESS: 707 Wilshire Blvd. CITY/STATE/ZIP: Los Angeles CA. 90017 <br /> PHONE (1): 323-605-6639 PHONE (2): 213-596-6175 FAXORE-MAIL: Lmartin@kleinfelder-, <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 /> ❑!cNl�; ciic � cp�pJrp�pdU �" d3oik� !,to N,aM cwohiy [��iaEs ,eacEso '� iisiy $d.s <br /> SIGNATURE OF APPLICANT DATE MA✓c(., 01201 Lo <br /> Electronic Information: ❑ LIV❑ Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> $treat9 Street Name city <br /> F4.2 <br /> 4221E. Mariposa StocktonUnit 1 <br /> Unit 2 [(r <br /> ❑ unit 2H O GSA <br /> 5 Nr/unit 3 <br /> 6. Unit 31-110 <br /> ❑Unit 4 <br /> 8 <br /> ly <br /> SITE MITIGATION <br /> 9. unit 5 <br /> 10. <br /> Specific Date Range of Information Requestad: From to <br /> N•VCkt��f1111�N7j�rW;HEA4Y1�`.pEPv4RTM6NS Fll:�S. <br /> P1 UNDERGROUND TANK(UST)CLEANUP SITE(LO� P) MOTELIHOTEL SOLIDWASTE FACIHTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LDP) ❑HOUSINGABATEMENT [I FOOD FACILITY <br /> ©UNDERGROUND TANK(MONITORINGIREMOvAL) Q WASTE TIRE DAIRY,POOLISPA <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL 0 WASTEWATER TREATMENT PLANT <br /> Q HAZARDOUS WASTE F41 MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [Z]HAZARDOUS MATERIALS ❑TATTOOIBODY 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 8:00 AM-5:00PM EXCLUDING HOLIDAYS <br /> 1. 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(209)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 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 (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-EHD USE ONLY-- <br /> [1103 Records provided by Staff-PPR Complete. Staff Name: ®e <br /> 1Z1-d 100/100'd W-1 ZYZ61Z1e96+ SN13AI111N-lu0fd wd91:Z1 910Z-6Z-e0 <br /> 9■® <br />