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DATE I �ED EHD LOG NUMBER <br /> $,+� '1� SAN �OAQUIN COUNTY <br /> &3 0 2011 tNVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/Fl Y <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ICerran Pender Partner Engineering and Science <br /> APPLICANT: BUSINESS/AGENCY: --_—_— 9 9 _--__ <br /> ADDRESS: <br /> 900 Second Street Suite 415 City/State/Zip San Francisco, CA <br /> PHONE(1): _415-962-4755PHONE(2): FACSIMILE: <br /> 917-710-2770 1-800-419-4923 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Kerran Pender DATE 8/29/11 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS _ —�FHD USE ONLY <br /> Street# Street Name City l � ��rCf <br /> Auto Plaza Way A) Tr InCQ2 "& ❑ Unit 1 <br /> A <br /> 1. 2680 y Tracy A "7 <br /> 2. 3450 Auto Plaza Drive Tracy �— r=fq � �3�� Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. - -- - -- --- -- - ---- --- <br /> 6. r� ,� Unit 4 <br /> 7. -- -- ❑ Unit 5 <br /> 8. <br /> 9' a {( X Unit 6 <br /> 10. ` <br /> Specific Date Range of Information Requested: From _ to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOL/SPALAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 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. 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)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 same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />