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■■�: Ling Cao Fax:{626)346-7788 To. 2094640138&cfax.coo Fax: f209j 464-0138 Page 1 of 1 06701!2017 10:43 AM <br /> ■ <br /> I V SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> ■ <br /> .SUN 0 1 2017 0-1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> �i/r�6QN�A1.FAN <br /> PEMITr SCEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Amada Lagunas BUSINESSIAGENCY: Fulcrum Environmental <br /> ADDRESS: 517 South Ivy Avenue CITY/STATE/ZIP: Monrovia, CA 91016 <br /> PHONE(1): 626-228-7361 PHONE (2): FACSIMILE: 800-385-7126 <br /> oma da Fenviro.com <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 appoi tment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST 130 FEE(C H OR CHECK ONLY)- REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6-1-17 <br /> Electronic Information: ❑ List ❑ Map—Description: hazardous releases/materials; UST/AST; septic systems <br /> FILE ADDRESS EHD USE ONLY 1?1711E ,� <br /> Street# Street Name City <br /> 1. <br /> 11900 East Locke Road Lockeford i�P�41 /C W16Vl <br /> 2. <br /> 3. <br /> 4. �� <br /> 5. SITEGATiON <br /> 6. 0 <br /> 9, Gt rpA -(A13 �' <br /> 10. _ [( M <br /> Specific Date Range of Information Requested: From all to all <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) [3 HOUSING ABATEMENT ®WASTE TIRE <br /> UNDFRGROUND TANK(MONITORING/REMOVAL) ❑FoOD FACILm ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ®WASTEWATER TREATMENT PLANT <br /> [RHAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILrrY ❑POOLISPA LAND USE APPLICATION SITES <br /> ❑TATToolBODY PIERCING [XCOMPLAINTIRESPONSE 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 notifythe applicant if any EHD tiles 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. Anyfile 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 $125 deposit prior to review. ***BOXED AREA -EHD USE ONLY*** <br /> ' -t`( 4L,.e A. &,, <br /> t <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> ewn AR-fir; 5111115 <br /> Received Time Jun, 1. 2017 10:44AM Nilo- 1618 <br />