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DATE RECEIVED Z G 9 O C N W! Z l 9 l O Z 6 Z 'a eWE"a W i j`'p alA I a a a d <br /> SAN JOAQUIN CG.,?.. . <br /> ENVIRONMENTAL. HEALTH DEPARTMENTe <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232- ' <br /> 1-MAR 2 9 201 <br /> Ti eleAhvne: (203) 468-3420 Fax: (209) 464-0138 Web. www.sjgov.org/ehd <br /> ��I1fICOf� iEIviTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 0C! I nrrs <br /> APPLICANT: Leticia Martin SUSINESv/AGENCY: Y-�ey)k -f-y <br /> ADDRESS: 707 Wilshire Blvd. CITY/STATE/ZIP: Los Angeles CA. 90017 <br /> PHONE (1): 323-605-6639 PHONE(2): 213-596-6175 FAX ORE-MAIL: Lmartin@klcinfelder.� <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 /> ,iIr.,-Ir., .,in.•,r•- "� 'Qr1F.GCiI ` ','O}ai;'GNE�C "Ot+1L1'Y'��'� EQIJEbCES�S�D�:I1+1�,3US;N�S' bd'4s <br /> �HClfitOY?E�;t. Cp1TLt�a „X 3 <br /> SIGNATURE OF APPLICANT _ DATE Ma✓ dal?-01 to <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 1' 4221 E. Mariposa Stockton <br /> w/unit 1 <br /> 2. <br /> 3. Unit 2 , r <br /> 4. J� `'�� <br /> I t ❑ unit zw �- <br /> 5. I I 0 Unit 3 <br /> 6. <br /> Q unit 3HM <br /> 7. ❑Unit 4 <br /> S. EYSIITE MITIGATION <br /> 9. <br /> � � <br /> 0. / / Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) f MOTELIHOTEL SOLID WASTE FACILITYNEHICLE <br /> Q OTHER CLEANUP SITE(NON•LCP) [I HOUSING ABATEMENT ❑FOOD FACILITY <br /> Q UNDERGROUND TANK(MONITORING/REMOVAL) [ WASTE TIRE Q DAIRY,POOLISPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL WASTEWATER TREATMENT PLANT <br /> [.�HAZARDOUS WASTE [✓ MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ©HAZARDOUS MATERIALS ❑TATTOOISODY PIERCING ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY ❑J COMPLAINT/RESPONSE RECORDS [)OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00FM(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 approprlate <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 flies 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 /> ***BOXED AREA-EHA USE ONLY— <br /> 0 Records provided b_Staff-PPR Complete. Staff Name_ ee <br /> ■ ■ <br /> ■ <br /> 2Z2-d 100/100'd 660-1 ZfZ62Z206+ 63013A131N-w0JJ md91:Z1 9lOZ-6Z-EO ■� <br /> ■ ■ <br />