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PM Bas i ^s Environmental, Inc 510`-"49098 P.1 <br />■ <br />NTE RECEIVED SAN aIOAQUIN COUNTY 61-110 LOQ NUMBER <br />�■ JAN7 2013 ENVIRONMENTAL HEALTH DEPARTMENT A04 <br />ENVIRONMENTAL1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ot�'bone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />� l`!MITISERVIC� <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 5AM LoIJ6,? BUSINESS/AGENCY: l'ASQ_-S Grjy1QeNM6l.)q'A1-,1►JG. <br />ADDRESS: (S� 1ZT4 iTt r -Cr Sere 17.4K- <br />b \ CITYISTATE211P: QALk1Z0 C1ti 0m6o <br />PHONE (1): 1p1 131LI 0cl91 PHONE (2): (S4 2)2,0'1 "b1g; I FACSIMILE: (r,_l c) 01 g <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 appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE RE,QU $1:0 FEE (CAS.OtR CHECK ONLY) -REQUEST PROCESSED IN J BUSINESS DAYS <br />SIGNATURE OF APPLICANT S % i DATE I (-I � I Icj <br />Electronic Information: ❑ List ❑ Map — Description: <br />ADDRESS <br />EHD USE ONLY <br />Street <br />_ ____FILE <br />Street Name <br />CP Cl <br />City <br />1■ <br />7- <br />bGK O.J <br />11Y `� 1��7✓� (t1/ �l <br />Unit 2 <br />2. <br />3. <br />Ey/unit 3 <br />4. <br />= 'Unit 4 <br />B' <br />----- <br />7. <br />Unit 4 <br />8. <br />9. <br />'Un It 0 <br />0• <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMEcN'r FILES <br />�DEROROUND TANK (UST) CLEANUP SITE (LOP) D'MEDICAL WASTE FACILITY Q S LID WASTE FACILITYNEHICLE <br />[�7HER CLEANUP SITE (Nrw-LOP) ❑ HOU9IN0 ABATEMENT ASTE TIRE <br />DER©ROUND TANK (MONITORINOIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />BOVEOROUNDTANK ❑ CHICKENRANCHI DOO KENNEL ASTEWATERTREATMENT PLANT <br />RDOUS WASTEIHAZARROUS MATEPJALG ❑ MOTELIHOTEL LIMPER TRUCKIYARDICHEMICALTOILETS <br />FRED PERMITTED FACILITY POOL/SPA BLAND USE APPLICATION SITES . <br />❑ TATTOOIBODY PIGRCINO ❑ COMPLAINTIRESP'ONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT IRt:CORDS ARE AVAILABLE FOR REVIEW MONDAY -FRIDAY a:00 AM-S:OOPM EXCLUDING HOLIDAYS) <br />1. Llet up to ten acldxMftA In the speoe shove. SQIact the types) of files from the flat above by checking the appropriate <br />box(es). Al least one file type MUST be selected. Fax to (209)464-01§8 S2 mall to the oddragLe_Ind lcated ebQys. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next buslneee day. <br />2. For tavelstance In IdartIfying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. The EHO will notify the applicant 11 any EHD files exlet. An appointment for review will be confirmed approximately tan (10) <br />days after recelpZ of appll(:atlon. The fllos will tic held for a maximum of five business days for review. Appolntn)onts <br />should be Scheduled accordingly. <br />4. Any file not returnad In the name condition as released will be reorganized by EMD staff at the expense of the Applicant. <br />Future file revie'r t hy'ha clamp appllcnnt may reculru a $130 deposit prior to rraview. '"PDXED AREA -EMD USE ONLY' <br />I,>A <br />�A r- alt r <br />0 Records prt?viz9R a'_y-Staf�•PIa4 r:om lete�atatl Name: <br />'Received T i6` _Jan, 26.=2015= 4:54PNFNo._7a5_ � <br />