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®® SAN JOAQUIN COUNTY EHo LOG NUMBER ■ ■ ® ENVIRONMENTAL HEALTH DEPARTMENT ' OCT 2 0 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 466-3420 Fara: (209) 464-0136 Web. www.sjgov.org/ehd ENVIRONMENTALHEALTH pr=eMlTi,E9V10E PUBLIC RECORDS RELEASE APPLICATION 11 APPLICANT: Lita Freemaxl ADDRESS: 1420 E Roseville Pkwy, #140-262 PHONE (1): 916-677-9897 PHONE (2): BUSINESS/AGENCY: ,AEI Consultants CITY/STATE/ZIP: Rosevffie, CA. 95661 FACSIMILE; Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK SOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANTr�= -��-��c'Ta-�,-�- DATE .0/10/14 Electronic Information: ❑ List [] Map -- Descriptjort: FILE ADDRESS EHO USE ONLY Specific Date Range of information Requested: From 1940 to Rreseznt ENVIRONMENTAL HEALTH DEPARfM-ENT FILES ® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ® SOLID WASTE FACILITYNEMICLE OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <2 t7 �'s 160 Pr_ ® UNDERGROUND TANK (MONrrORING/REMOVAL) El FOOL) FACILITY ❑ DAIRY i 1 j ® r_:,OVEGROUND TANK ❑ CHICMN RANCH/ Doe KENNEL ❑WASTEWATER TREATMENT PLANT / ® HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑ MOTELMOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS ® TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ TATTOOIBODY PIERCING X1 COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ton_addresses In the space above, Select the type(s) of files from the list above by checking the appropriate box(es). At least one fife type MUST be selected. Fax to (209) 464 -013B -or mail to the address Indicated above. Address ranges will not be accepted. Applications received after 3.00 pm wjjl be processed the next bualness day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any SHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appojntments should be scheduled accordingly. 4. Any file not returned In the same condition so released will be reorganized by Eli® staff at the expense of the applicant Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA - EHD USE ONLY"" 17111+J.iY =i , . LWI a Cro vi clod ctlM ' • Street # Street Name city ❑ Unit 1 1, 1. 1919 N_ Broadway Avenue imStockton +#� _WnK1_1 Aq7 i� s N. BroadwayAvenu Stockton unle 2- 2. 1905 3, nit 3 4. 6, Unit 4 8' 7. © Unit 5 8. 9. ,P I�VRIt 6 10. Specific Date Range of information Requested: From 1940 to Rreseznt ENVIRONMENTAL HEALTH DEPARfM-ENT FILES ® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ® SOLID WASTE FACILITYNEMICLE OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <2 t7 �'s 160 Pr_ ® UNDERGROUND TANK (MONrrORING/REMOVAL) El FOOL) FACILITY ❑ DAIRY i 1 j ® r_:,OVEGROUND TANK ❑ CHICMN RANCH/ Doe KENNEL ❑WASTEWATER TREATMENT PLANT / ® HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑ MOTELMOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS ® TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ TATTOOIBODY PIERCING X1 COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ton_addresses In the space above, Select the type(s) of files from the list above by checking the appropriate box(es). At least one fife type MUST be selected. Fax to (209) 464 -013B -or mail to the address Indicated above. Address ranges will not be accepted. Applications received after 3.00 pm wjjl be processed the next bualness day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any SHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appojntments should be scheduled accordingly. 4. Any file not returned In the same condition so released will be reorganized by Eli® staff at the expense of the applicant Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA - EHD USE ONLY"" 17111+J.iY =i , . LWI a Cro vi clod ctlM ' •