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07/12/2010 11: 37 91686160 STANTEC PAGE 02/02 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 1J I � ENVIRONMENTAL HEALTH DEPARTMENT <br /> �l��C,ll 600 East Main Street, Stockton, CA 95202-3029 4(p Ij 1 2 L,IoTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> �1 1hiH'_(4ALTH PUBLIC RECORDS RELEASE APPLICATION <br /> �IMip wfs lNl arming BU5INESSIAGENCY: Stantec Consulting Corporation <br /> ADDRESS: 3017 Kilgore Road, Suite 100 Dity(statnrzip Rancho Cordova, CA 95670 <br /> PHONE(1): (916) 384-0706 PHONE(2): (916) 281.4942 FACSIMILE: (916?661-0430 <br /> TENTATIVE'APPOINTMENT DATE: July 20, 2010 Time: 10:00 am <br /> (Please allow 10 business days from data of application Submittal•"renfadve only-count be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE UEST-$10 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3/BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7( V&) <br /> 1 <br /> Electronic information; © List© Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Nam city Unit 1 <br /> 1. 7647 Pacific Avenue Stockton <br /> U�H2 <br /> 3 ... . .. .........—...-- --- n O <br /> 4 Unit3 ,1 <br /> ------------- __._. <br /> 5. <br /> '--_. ..._. _-------.........__ Units <br /> 6. <br /> 7. <br /> ❑ Unit <br /> S. <br /> 9' — l7 Unite <br /> Specific Date Range of Information Requested: From 1865 to Present / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES L, <br /> ISi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MHOUSINO ABATEMENT ❑SOLID WASTE FACIUTYIVEHICLE <br /> ®OTHER CLEANUP SITE INON-LOP) O FOOD FACILITY M WASTE TIRE ! Y// <br /> 0 UNDERGROUND TANK(MONITORINOL O IREMOVAL)oDDGKENNeL 11 DAIRY 1 <br /> m HAZARDOUS WASTE GENERATOR V M' O CHICKEN RANCH 71 WASTEWATER TREATMENT PLANT <br /> [InTIERED PERMITTED FACILITY IJ^ ❑MOTEL/HOTEL El PUMPER TRucrJYARDlCHEM TOILETS L/ <br /> 13 TATTOOfBODY PIERCING 0 POOLISPA G LAND USE APPLICATION SITES <br /> CI MEDICAL WASTE FACILITY L7 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY•Fn DAY S:00 AM•6:OOPM • EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses in the space above. Select the 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)4640138 or mall to the address indicated_ab_ove._ 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 flies 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 $106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 464)S OtC4106 PUBLIC RECORDS RELEASE APP FORM <br />