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DATE/RECEIVED � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ^ /1 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd i `V <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Donavan Tom BUSINESS/AGENCY:Basics Environmental, Inc. <br /> ADDRESS: 65512th Street, Suite 126 CITY/STATE2IP:Oakland, CA 94607 <br /> PHONE(1): 510-834-9099 PHONE(2): FACSIMILE:510-834-9098 <br /> TENTATIVE*APPOINTMENT DATE: 9/14/12 Time: 10 am <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT See Below DATE 9111112 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> ,t Street# Street Name City ❑Unit 1. <br /> l� 1. 9484 West Lane Stockton (j rj l� <br /> 2• ❑Unit 2 <br /> 3. / <br /> 4. Unit 3 <br /> 5. �l <br /> 6• �L Unit4 <br /> 7. <br /> 8, ❑Unit 5 <br /> 9. <br /> i0• _�dunit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X❑UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑MEDICALWASTE FACILITY X❑SOLID WASTE FACILITYNEHICLE�j 1 <br /> X❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT X❑WASTE TIRES fj IPS //V <br /> X❑UNDERGROUND TANK(MONITORINGIREMOVAL)D ❑Foot)FACILITY ❑DAIRY q"IZZ- <br /> X❑A9OVEGRO4addre <br /> ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X❑HA ARDOU C� ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> X❑TIE PE ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ TATTOOI X❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND CORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u tothe space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). 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 samiq Applicant may require a$125 deposit prior to review. i"BozeO AREA-Eeo USE_ONLY <br /> Iz I Z U I�- IZ v <br /> 12'IZ 1 558r IO 5 i <br /> gy 4 was a!' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> ��n.arG <br />