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09/25/2012 11:54 5308722962 PAGE 01/01 <br /> u � <br /> DATE RECEIVED ® EHD LOG NUMBER <br /> .JOAQUIN COUNTY <br /> ����� "�i ENVIRONMENTAL HEALTH DEPARTMENT <br /> Qi <br /> 600 East Main St. Stockton, CA 95202-3029 �` <br /> QiLphone: (209)468-3420 Fax: (209)4640138 Web:www.sjgov.org/ehd <br /> TALF(EALIFURLIC RECORDS RELEASE APPLICATION <br /> �TrP�RMITIS <br /> APPLICA T: Wendy Digiomo BUSINESS/AGENCY: Pinnacle Environmental Inc <br /> ADDRESS: PO Box 1956 CITY/STATE/27P: Paradise, CA 95967 <br /> PHONE(11): 916/606-3330 PHONE(2): FACSIMILE: 630/872-2968 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tenfeave only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT— Gt/D DATE 9-2S-2012 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name city <br /> - <br /> Unkt <br /> Dun�?�5 <br /> 1. 2513 Station Drive, Stockton }hal ( NP <br /> 2 ❑unit <br /> J J� 3 // I <br /> 4. 17 UnIt 3 <br /> 6. �]Unit 4 <br /> 7. <br /> k10 <br /> — ❑units <br /> . ❑Unit 6 <br /> Specific Date Range of Infornatlon Requested: From to <br /> ���yyy ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACMYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE k '(,(/7 df"3. <br /> 29 UNDERGROUND TANK(MONITORINGIREMOVAL)i/, ❑DOG KENNEL ❑DAIRY (b/M1•( 10-Y-12 <br /> RHA7ARDOUS WAsTE'GENERATORp1- ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMrrTED FACILITY(/— ❑MOTELMOTEL ❑PUMPER TRUCNIYARDICHEMICALToms <br /> TATTOO/BODY PIERCING 0 POOL/SPA ❑LAND USE APPUCATioN SITES <br /> ❑ MEDICAL WAsTEFACnm lfXOTHER(PLEASE SPECIFY) 114.2�og p /;%�k'jj; hgAdl <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDIN"OLIDAYS) <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 209 494-0138 or mail 1P 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(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 /> 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)488.3425. <br /> AHO USE ONLY /'- <br /> iAlo _ 1 <br /> EHD CB•e6 <br /> x/27/09 <br /> Received Time Sep, 25. 2012 11 : 30AM No. 1205 <br />