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DATE RECEIVED EHD LOG NUMBER <br /> SAN �lOAQUIN COUNTY <br /> RECEI®,/� ENVIRONMENTAL HEALTH DEPARTMENT <br /> �f 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �� <br /> Telephone: (209) 468-3420 Fax: 209 464-0138 <br /> ��� � � ���� ( ) Web: www.slgov.org/ehd <br /> EPUBLIC RECORDS RELEASE APPLICATION <br /> �ivir IIPYfI[iL-FNIIJV_iPF.l6[ �x.c _ <br /> APYLOAMERVIGWrie Lang BUSINESS/AGENCY: Arcadis <br /> ADDRESS: 101 Creekside Ridge Court,STE 200 CITY/STATE/ZIP: Roseville,CA 95678 <br /> PHONE(1): 916-786-3171 PHONE(2): 432-312-7687 FAX OR E-MAIL: <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 /> E]CHECK BOX TO EXPEDITER `T-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 12/9/15 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. 5950 N.Highway 99 Stockton ,/L)o <br /> 2• 6100 N.Highway 99 Stockton U, Unit 1 <br /> 5" 0 � <br /> 3. 5942 N.Highway 99 Stockton kn Gl p� GI I <br /> LV"/ r I ❑ Unit / <br /> 4. 5940 N.Highway 99 Stockton <br /> 5. 7840 ig way • • <br /> Stockton <br /> 6. Q-0-nit 3 <br /> N0 4 � Nd c0/ <br /> 7. [1Unit 31AM <br /> Sl nit <br /> 8. <br /> ❑SITE MITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ri <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [I MOTEL/HOTEL3 �I <br /> ❑OTHER CLEANUP SITE(NON-LOP) E]HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> El FOOD®UNDERGROUND TANK(MONITORING/REMOVAL)V, ❑WASTE TIRE <br /> ABOVEGROUND TANK ❑DAIRY,POOL/SPA <br /> FACILITY <br /> iX AIR <br /> ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY <br /> El HAZARDOUS MATERIALS El PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINT/RESPONSE RECORDS <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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.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. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. <br /> ""BOXED AREA-EHD USE ONLY* <br /> A?S SD t,4' i <br /> Q r'0 U do <br /> 0De, 'i ('9ID0 I W. <br /> a - me: <br /> r�J:.ra 7PT,l;tarl U (aD f c1 <br />