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/'i 10 SAN JOAQUIN COUNTY 40 FE <br /> M I i LLOEUM61ji"' 'i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> }; N 2050 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> t`S/ <br /> ENVIRONMENT PUBLIC RECORDS RELEASE APPLICATION <br /> F Rr��e�ris��uic�s <br /> APPLICANT: Kerran Pender BUSINESS/AGENCY: Partner Engineering and Science <br /> ADDRESS: 1990 East Grand Avenue, Suite 100 City/State/Zip E1 Segundo, CA 90245 <br /> PHONE(1): _415_962-4755 _ _ PHONE(2): _917_710-2770___ FACSIMILE: 1-600-419-4923 <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 1/22/10 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. 1535 East Pescadero Avenue Tracy 7 E] <br /> 2. Unit 2 Q� <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> low <br /> 9. <br /> 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 M SOLID WASTE FACILITY/VEHICLE <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY M WASTE TIRE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH [a WASTEWATER TREATMENT PLANT <br /> E2 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ISLAND USE APPLICATION SITES <br /> 17 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 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />