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126/15 08 : 41AM PDT ' 8664862388 ' —> 2094640138 Pg 2/2 <br /> DATE RE_CEIVEb - EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> i14 r 66 East <br /> ENVIRONMENTAL <br /> Avenue, Stockton, CA 9 205 6 32 <br /> PARTMENT <br /> 18 t i <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.orglehd <br /> — � <br /> PUBLIC RECORDS RELEASE APPLICATION �)APPLICANT:CCG 'ba BUSINESS/AGENCY: Ob <br /> ADDRESS: a ,'IIZ( Vl_I�rn rT�/l/j <br /> Wtti CiTYISTATEIZIP: �YJ l� ` ?- <br /> 1 PHONE(1): ��RO�.�_Zh PHONE(2): _ _,---, FACSIMILE: 1. <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 T-$130 PE (CA,�H OR CHECK ONLY)-REQUEST PROCESSED IN 3 6 SINES DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DATE (c (O <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> -- - Stroot Y SIMM Name City I�r ❑Unit 1 <br /> 1 3301 • iruc �ulr✓� iraC `F <br /> 23L� _ lie u/ryCtr mac' = aunit_z <br /> �r <br /> 3 3�3_ .lvouJeyctr_ TCu cl ; <br /> 4 ;3v�1 3�l_ �f31� � 2 -l— �,`;�' fv i /! _0 <br /> Unit_3 <br /> 6, 7 SITE MITIGATION <br /> 8 L(Unit 6 <br /> S. <br /> 10. -- Unita <br /> Specific Data Range of Informatloo Raqueated; From to <br /> RTM <br /> ���cccyyylll ENVIRONMENTAL H LTH DEPAENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE,FACILITY ❑SOLID WASTE FACILITYNEHICLF. <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANcW DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING RCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEW: MONDAY-FRIDAY 8:00 ANI-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. Llet u an addeossos In the space above. Select the type(a)of files from the list above by checking the appropriate <br /> box(es). At least one Ole type MUST be selected. to( OS)484.0138 or dyII�Q 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 IdenUlying 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 EMD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The alae will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any Ole not returned In the some condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future Ole reviews by the same applicant may require a$126 deposit prior to review. "'BOXED AREA•EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. Starr Nama_ <br /> srnns <br /> EHD U-DB <br /> Received Time Jun, 26. 2015 8:40AM No. 9053 <br />