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I■ <br />■ :Lin Cao Fax: (800 385-7105 To: 2094640138@rcfax.cor Fax: +12094640133 ige 1 of 1 0711312015 1:5^o PM <br />`Dr1 EI I„�� SAN JOAQUIN COUNTY EHD LOG NUMBER <br />■ IVED <br />I M 11111 ENVIRONMENTAL HEALTH DEPARTMENT <br />■■ JUL 13 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH 0/ <br />�y <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Amada Lag nas <br />ADDRESS: 2610 Gardi Street <br />PHONE (1): 626-228-7361 <br />PHONE (2): <br />BUSINESS/AGENCY: Fulcrum Environmental <br />CITY/STATE/ZIP: Duarte, Ca 91010 <br />FACSIMILE: 800-385-7126 <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arra a a4apoii tmentdate and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUE -$1SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 7/13/2015 <br />Electronic Information: ❑ List ❑ Map —Description: hazardous releases/materials; UST/AST; septic Ustems <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name <br />City <br />1.1 <br />2325 <br />West Charter Way <br />Stockton <br />►^^�, �� LL,et,>,-Cite <br />❑ Unit <br />2. <br />Ir?S' /r( �� <br />/ <br />'? �.� j%'+ ,"1: 1� i (� <br />3. <br />J <br />El Unit 3 <br />El SITE MITIGATION <br />r.7 <br />J�`yJeA 4 cl(gS 1v4 Unit 4 <br />((� <br />�'tb� j 171 Unit 5 <br />9. <br />Unit 6 <br />10. <br />Specific Date Range of Information Requested: From all to all <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />[UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <br />[OTHER CLEANUP SITE (NON -LOP) LN HOUSING ABATEMENT EX WASTE TIRE <br />[UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />[ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />E1HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />[TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING LXCOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <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. Selectthe 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. 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. Anyfile not returned in the same condition as released will be reorganized by END staff atthe 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 />11 2325 West Charter Way, Stockton, CA 11 <br />11 ❑ Records provided by Staff -PPR Complete. Staff Name: 11 <br />FHn as.nr 5/11115 <br />Received Time Jul, 13. 2015 1:58PM No.9139 <br />