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DATE RECEIVED - A • • EHD LOG NUMBER <br /> \ SAN .10AQUIN COUNTY <br /> () _yj(�•i� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��/�+✓mil' (r Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> Q PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Tina Cheney BUSINESS/AGENCY: Neil O. Anderson &Associates <br /> ADDRESS: 902 Industrial Way CITY/STATE/ZIP:Lodi, CA 95240 <br /> PHONE (1): 209-747-0640 PHONE (2):209-367-3701 FACSIMILE:209-333-8303 <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-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Tina Cheney DATE September 25, 2013 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 1340 W.Charter Way Stockton • <br /> 2. 1310 W.Charter Way Stockton ❑ Unit 2 <br /> 3. 1323 W.Charter Way . Stockton <br /> 4. 1245 W.Charter Way 3S24o — Stockton • Mnit 3 <br /> 5. 1145 W.Charter Way _D10,.�7,1 Stockton • <br /> 6. 1501 W.Charter Way bfil -q 6 tockton • 3 - (e CA I a Unit 4 <br /> 7. 1819 S.ArgonautSt Z460 Stockton <br /> 8. 1777 S.Argonaut St AleStockton ❑ Unit 5 <br /> 9. 1745 S.Argonaut St Stockton 3 <br /> 10. 1 1 ❑ units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILnY X SOLID WASTE FACILITYNEHICLE <br /> X OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> X UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD_FACILITY. .. _ _ _ ❑DAIRY _-- <br /> XABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILEfS <br /> X TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOo1BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑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 un 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$125 deposit prior to review. —BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />