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05-28-°13 11:16 FPOM-Geolo-'�,al Technics T-937 P0001/0001 F-543 <br /> pi JEHD LOG NUMBER <br /> R SAN .10AQUIN COUNTY <br /> g 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> . <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ,ENVh-j�NMN�p�HEp�F. 01epFtone: (209) 468-3420 Fax: (209)464-0138 Web: wwW.sjgov.org/ehd <br /> P["l1(v31 T�SER11ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jenny Weese BUSINESSIAGENCY: Ground Zero Analysis <br /> ADDRESS: 1172 Kansas Avenue CITY/STATE/ZIP: <br /> Modesto, CA 95351 <br /> PHONE(1): 209-522-4119 PHONE(2): FACSIMILE: 209-522-4227 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Pleaso allow 10 business days from date of application submittal-`Fen(ative only-must bo confirmed) <br /> ❑CHECK BOXTO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> i <br /> Street# Street Name City , ]Unit 1 <br /> 1. 2811 E. Fremont Street °,sem Stockton <br /> 2. <br /> Unit 2 <br /> 3. / <br /> 4.5. <br /> �Unit 3 <br /> 6. 2� 1]�Jnit 4 <br /> 7. <br /> S Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requasted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLIDE T ASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F1 HOUSINGWAST <br /> ABATEMENT ❑ <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> RABOvEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS to OTHER(PLEASE SPECIFY) S W E <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 fifes 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 new application may be <br /> submitted when the file is available. <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. ,=6oXED'AREA EHD USE ONLJ <br /> q Records provided by Staff-PPR Complete. Staff Name: <br /> 914112 <br /> EHD 48-06 - <br /> Recei,ied Time May. 28. 2013 11 : 18AM No, 3201 <br />