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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> / ENVIRONMENTAL HEALTH DEPARTMENT v <br /> / 1868 East Hazelton Avenue, Stockton, CA 95205-6232 d <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Heather Nilson BUSINESS/AGENCY:Andersen EnVirOmental <br /> ADDRESS: 5261 West Imperial Highway CITY/STATE/ZIP: Los Angeles, CA 90045 <br /> PHONE (1): 310-854-6300 PHONE (2): FACSIMILE:310-854-0199 <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2/10/2015 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 2-48(even) W. Weber Ave. Stockton gip, <br /> 2. 21-47(odd) N. Center St. Stockton �d�a'"`� ❑ Unit <br /> i <br /> 3. 33-47(odd) W. Main St. Stockton �L-Ski-115 <br /> 4. 2-48(even) N. Commerce St. Stockton ❑f-Unit 3 <br /> 5. <br /> 6. El <br /> 4 <br /> 7. <br /> 8. ❑ Units <br /> 9. <br /> 10. El Unit 6 <br /> Specific Date Range of Information Requested: From Earliest to Present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑o UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑■ OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ❑■ UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑■ ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ■❑HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ■❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT/RESPONSE 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 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.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 END 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. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 08/01/14 <br />