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DATE FCEIVED � EHD LOG NUMBER <br /> r SAN JOAQUIN COUNTY - <br /> �E ,LI _.�J ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> NPI Z009 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsjgov.org <br /> EN�RU",IN1 N[ I iEAJ'H PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: --___-_,,BUSINESSIAGENCY: Partner Engineering and Science <br /> 2101 Rosecrans Ave, #I4270 E1 Segundo, CA 90245 <br /> ADDRESS: �____-- City/State/Zip <br /> 917-710-2770 1-800-419-4923 <br /> PHONE(1): 415-962-4755 PHONE(2): FACSIMILE: <br /> TENTATIVE'k 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 xerran Pender DATE 3/2S/09 <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. 3776 West Grant Line Road Tracey ❑ <br /> 2. 110,Unit 2 <br /> 3. / U A 3 \r v <br /> 4. <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑ unit s <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From _ 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACiLITYIVEHICLE <br /> M OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY M WASTE TIRE <br /> M UNDERGROUNDTANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> © HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH CZ WASTEWATER TREATMENT PLANT <br /> IS TIERED PERMITTED FACILITY ©MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 173 TATTOo1BODY PIERCING ❑ POOLISPA 0,"LAND USE APPLICATION SITES <br /> I3 MEDICAL WASTE FACILITY 0 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 flies 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 mall 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 8104148 PUBLIC RECORDS RELEASE APP FORM <br />