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DATE CEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> P000 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> Kerran Pender Partner En ir. and sc.i. <br /> APPLICANT: -- --_--_—_---__--_--_ _BUSINESS/AGENCY: — neer_ <br /> —_--- 9 —_— 9 ----_ -c�nre <br /> ADDRESS: 400 Second Street Suite 415 City/State/Zip San Francisco, CA <br /> — <br /> --------------------------- <br /> PHONE(1): _415-962=4755 —_— — _- PHONE(2): _917-710-2770_ 1-800-419-4923 <br /> FACSIMILE: <br /> TENTATIVE' APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) I ILE COPY <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 FHHDU_SE ONLY <br /> Street# Street Name City <br /> Auto Plaza Way ,a) Trc (n�1 ❑ Unit 1 <br /> 1. 2680 y Tracy <br /> 2. 3450 Auto Plaza Drive Tracy 6'T_— �F� � `Z 3�� Unit 2 <br /> 3 _ L7 -T­r'�cam/ <br /> 4 Unit 3 <br /> 5. .. . . . - -- { ✓ <br /> 6. Unit 4 <br /> Lf �r 1' �. <br /> 7. / J <br /> - <br /> -- – – - - ❑ Unit 5 <br /> 8. <br /> 9. n <br /> Ot � �� ('( �'' Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )0' UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL �In DAIRY y.e <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL C]PUMPER TRUCK/YARDICHEM TOILETS <br /> 171 TATTOO/BODY PIERCING ❑ POOL/SPALAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑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 8104/08 PUBLIC RECORDS RELEASE APP FORM <br /> 4 <br />