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Rom: Leigh To: Fax: +1 (209) 4640138 Page 2 of 2 10113/2016 B:DO PM <br />DATEREC"EIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />�j ENVIRONMENTAL HEALTH DEPARTMENT <br />OCT1 rs L016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 814b05 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Ei'3V115100,0EWFIALHMTH PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Lei h Cloven BUSINESS/AGENCY: Pinnacle Environmental Inc <br />ADDRESS: 10 Ave. San Dimas, Unit B CITY/STATE/ZIP:San Clemente, CA 92672 <br />PHONE (1): 949)302-4404 PHONE (2):IeiahCa pei-env.cor OR E-MAIL: 8661845-4954 <br />Please allow 10 business days from date of pa plication 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 - $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Leigh Cloven DATE October 13, 2016 <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: I <br />Specific Date Range of Information Requested: From 01/01/1900 to 10%132016 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />IX UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />/, 20 <br />W. Turner Road <br />Lodi <br />n ❑ CONSUMER <br />��►-rr Cry ie� <br />HAZARDOUS WASTE <br />���yyy <br />TIERED PERMITTED FACILITY <br />`.� <br />12 <br />� <br />❑ DAIRY <br />ABOVEGROUND TANK <br />❑ PWS <br />[XUST (MONITORING I REMOVAL) <br />XHAZARDOUS MATERIALS <br />3 <br />SPILL/RELEASE RESPONSE <br />4 <br />WATER QUALITY <br />SOLID WASTE FACILITY / VEHICLE <br />FOOD FACILITY <br />❑ POOL ISP.4 <br />SITE MITIGATION <br />DAIRY <br />5 <br />F� LAND USE APPLICATION SITES <br />❑ HOUSINO <br />Ex SEPTIC PUMPER TRUCK / <br />YARD / CHEMICAL TOILETS <br />6 <br />F] WASTEWATER TREATMENT PLANT <br />CUPA <br />❑ HOUSING ABATEMENT <br />7 <br />F-1 MOTEL/HOTEL <br />CHICKEN RANCH I DOG KENNEL <br />GUPA- UST <br />MEDICAL WASTE FACILITY <br />a <br />TATTOO/BODY PIERCING <br />SOLID WASTE <br />WASTE TIRE <br />Ix COMPLAINT <br />9 <br />OTHER(PLEASE SPECIFY): <br />❑ ACGOUNTINIa <br />10 <br />"'BOXED AREA - EHD USE ONLY" <br />❑ Records provided by Staff -PPR Complete. staff Name: <br />'Received Time-Oct,11 -2016- 7:57PM-No.0158 <br />