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DAT fey SAN JOAQUIN COUNTY <br />ne t ENVIRONMENTAL HEALTH DEPARTMENT <br />b 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468.3420 Fax: (209) 464.0138 web: www.Sjgov.org/ehd <br />ENV RID t 11 ENI ALILEAM,. PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />r nrlrFj`h -dad BUSINESS(AGENCY: Odic Environmental <br />APPLICAN . <br />ADDRESS: 3255 Wilshire Blvd 0510 CITYISTAT IZIP: Los Angeles. CA 90010 <br />PHONE (1): 213-3£0-0090 PHONE (2): FAX OR E-MAIL frankt(wodicenv.com <br />Please allow 10 business days from date of application submittal forthe 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 - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANTDATE 06-05-16 <br />1. List uo to ton addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <br />box(os). 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 />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: _ 1 <br />Specific Date Range of Information Requested: From sso 10 zine <br />ENVIRONMENTAL <br />1 y <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />16-0 <br />EHD USE ONLY ta <br />FILES <br />® UNDERGIR TANK (UST) Q <br />Street # <br />Street Name <br />City <br />2115 <br />W. Yosemite Ave <br />Manteca <br />/yLlie <br />/ 1 <br />CLEANUP SITE (LOP) ` <br />(��1r <br />® OTIER CIGNUP SITE (NOII ) <br />z <br />2131 <br />W. Yosemite <br />f eta <br />/'1 <br />No NQ �1 CD <br />HKARODUS wasre <br />®TIERED PERMITTED FACIUTy 0 <br />.Ave <br />lam' / <br />® ABOVEGROUND TANK <br />• <br />• • <br />❑ P <br />/Q]'� <br />E US'( (MONITORING I REMOVALS / <br />®HAZARDOUS MATERIALS <br />J <br />® SPILLIREL'ASE RESPONSE <br />NATER (loony <br />®,I SOLO WAETE FACILITY I VEHICLE <br />l <br />FOOD FAGLIIY <br />SITE MMGATION <br />POOL I SPA <br />❑ ONRY <br />E <br />® LAND USE AVPLI nTION SITES <br />NaiilxG <br />® SEPMC PUMoER TPUCK/ <br />E <br />YARD I CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />UPA <br />❑ HOUSING ABATEMENT <br />T <br />❑ MOTEVHOTEL <br />GUPA- HAZ-MAT <br />❑ CMCKEN RANCH I DDD KENNEL <br />® IdE01C0. WASTE FACILITY <br />S <br />❑ TATT00/1300Y PIERCING <br />Souo W.:+e <br />® WAE.TE TIRE <br />9 <br />DUMP ANT <br />❑ A.C.U"- <br />❑ OTHER(PLEVSE SPECIFY): <br />10 <br />•..BOXED AREA -EHD USE ONLY-" <br />Received Time Jun. 5, 2016 9:37PM No.0835 <br />3 -1 <br />IDO <br />