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EHD LOG NUMBER <br /> DATE RECEIVED • SAN JOAQUIN COUNTY <br /> It? I� <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> `a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Grant Hurst BUSINESS/AGENCY: Geosyntec Consultants <br /> ADDRESS: 3043 Gold Canal Drive Suite 201 CITY/STATE/ZIP: Sacramento,CA,95670 <br /> PHONE(1): 916-637-8333 PHONE (2): 661-549-7627 FACSIMILE: 916-637-8321 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> tall will contact you to arrange an appointment date and time to review the requested records.'" <br /> CHECK BOX TO EXPEDITE REQUEST-$12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS n hJ J <br /> S NATURE OF APPLICANT f-"'- �� DATE-•� � + f <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 1. 212 Industrial Drive Stockton I0 <br /> 2. 248 Industrial Drive Stockton Fite- O Unit 2 Q <br /> 3. <br /> 4. IctIA Unit3 (� <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. <br /> 0 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> W 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(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑.CHICKEN RANCH/DOG KENNEL []WASTEWATER TREATMENT PLANT <br /> ® <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑PoOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY 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 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 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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY""" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48.08 4128114 <br />