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®UH ATE RECEIVED <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />❑ l <br />ENVIRONMENTAL HEALTH DEPARTMENTls!;� I % �5 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />VAK U 61b Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: v/v,/w.Sj90v.org/ehd <br />VIRONMENTAL HEY RELEASE APPLICATION <br />v p1 -[r llTll�rni ++nrn <br />y� <br />APPLICANT: Andrew Kim <br />ADDRESS: 3255 Wilshire Blvd #1508 <br />BUSINESSLAGENCY: <br />ENCON Solutions Inc. <br />CITYISTATEIZIP: Los Angeles, CA 90010 <br />PHONE (1): 213-380-0555 PHONE (2): FACSIMILE: 213-380-0505 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -=Tentative only- must be confirmed) <br />❑ CHECK COX TO EXPEDITE REQUEST - 5 FE (CASH OR CHECK CSNLY) - REQUEST PROCESS --D IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑ List ❑ Map – Description: <br />DATE 3-3-16 <br />_ FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street R <br />Street Name City <br />1. ! 1528 <br />East Fremont Avenue Stockton <br />, •NU L4- <br />P(MLJ' Ah) <br />2. <br />1533 <br />East Lindsay Street <br />I Stockton <br />3. <br />X 31 -P' <br />unit 3 <br />4. <br />5, <br />❑ Unit 4 <br />6. <br />%_ <br />Unit 5 <br />i <br />A-. RSpee)rDatapnngs of Inform, o on noyuAstGd. F,om. I io Ln <br />Ll� <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) f>_1 MEDICAL WASTE FACILITY Q SOLID WASTLFALfLiTYNEHICLE <br />Q OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ® WASTE TIRE ,C, F,0/^(aA MIf <br />® UNDERGROUND TANK (MON ITORINGIREMOVAL) � ❑ FOOD FACILITY ❑ DAIRY 1�J 3 . ��_ I , V <br />Z ABOVEGROUND TANK dL ❑ CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT MENT PLANT <br />® HAZARDOUS WASTEIHAZARDOUS MATERIALS p� ❑ MOTEL/HOTEL ® PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ® LAND USE APPLICATION SITES <br />❑ T ATT O0180DY PIERCING COMPLAINTIIRESPONSE RErnpOc ❑ riTIJCP (6LCAc� SPEC/ i ) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List un 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) 464-0138 or mail to 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 now application may be <br />submlited when the flle is avallable. <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 $125 deposit prior to review. —BOXED AREA - EHD USE ONLY`— <br />I 44 I /1 h i u -) U Ll j t c 1 n A • f.-)- <br />0 R®cords nrovidad by Staff -PPR Cnmniptp-etaff Name: <br />Received Time—Mar, 3.-2016— 4:20PM—No.0532 <br />