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emO- <br /> 579-2225 CardnoATC 10:50:12 12-22-2015 112 <br /> •� �� - JAN JOAQUIN COUNTY <br /> • z E V OWkONMENTAL HEALTH DEPARTIkONT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 X `� <br /> -5v <br /> DEC 2 2015 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd �} <br /> c-aVIROl4VIENT AL HEAL-1 H PUBLIC RECORDS RELEASE APPLICATION <br /> p0iViiilt tchk:v�_ <br /> APPLICANT: John Sellman BUSINESSIAGENCY: ATC Group Services LLC <br /> ADDRESS: 1117 Lone Palm Avenue,Suite B CITY/STATE/ZIP:-Modesto, CA 95351 <br /> PHONE(1): 2n9-579- ?1 PHONE(2): 209-872-5291 FAX OR E-MAtL:johnsellman@cardno.com <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 /> El RITE .. .. - , - .. -. .: . ... . <br /> CHECK.60X TO,EXPEDITE REQUES`f.-$130 FEE.(GASIi.OR.C_H.ECk ONLY)=REQUEST PROCESSES IN 3 BUSINESS PAYS <br /> DATE <br /> OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# _ Street Name city EHD USE ONLY <br /> 1. PN: 066-0 0-42 on Rio Blanco Rd.south of Ei t Mile Rd., Stock onAkk n <br /> 2. Cqr, <br /> p ,(J 'I')CC� ❑Unit 1 <br /> 3. S RI© 13kvlcO RC4 {7N <br /> P (,U �� ❑Unit <br /> 4. <br /> �6 5 El Unit 2H <br /> 2'-Unit 3 <br /> 6. <br /> 21 Unit 3HM ��1 <br /> Unft 4 <br /> 8. <br /> tib ITE MITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES t'�1 <br /> UN0EERGROUND TANK(USTj CLEANUF SfTE(LOP) ❑MOTEL/HCTEL ❑SOLID WASTE FACILITYIVEHIC <br /> LE <br /> ❑x OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY 4.A*-5 fo <br /> UNDERGROUND TANK N(MDNITORINGIREMOvALK I--]WASTE TIRE ❑DAIRY,POOUSPA y,/0> I- <br /> Q ABOVEGROUND TANK D( ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Q HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> Q HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑X TIERED PERMITTED FACILITY/- ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall 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. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. I � <br /> Future file reviews by the same applicant may require a$130 deposit riot to review. . Neo <br /> P E.om�nt- P c0(1}�403vo- e+(o <br /> "'BOXED AREA-EHD USE ONLY" WeC5V4,y,,WAtj +0 COQZ9g0 �. <br /> 'Ib <br /> (OM ©0 ib s t.)00o;?s (0 a> <br /> x 37573 g il0 cDU0ss l(a- DIOSIQ8 ) Plolb <br /> lrpo� <br /> 04 - 0 <br /> Received Time'Dec. 22. '2015'10: 58AN1-No. OM 17oH1 <br />