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'ME 11/05/2013 3:14PH FAX 31085401-n 40001/0001 <br /> I LOG C, RECEIVED SAN <br /> ;"dU1,18ER <br /> �� ATE SAN JOAQE�IN COUNTY EH <br /> Ii RE_ ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� 1868 East Hazelton Avenue, Stockton, CA 95203-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: %.rAw,/.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: LaLiren Sagun BUSINESSfAGENCY: Andersen Environmental <br /> ADDRESS: 433 Airport Bled.; Suite 406 CITYfSTATE/ZIP: Burlingame, CA 94010 <br /> PHONE(1): 415-316-6334 PHONE(2): 310-854-6300 FACSIMILE: 310-864-0199 <br /> TENTATI VE*APPCIN T HENT DATE: 11115/13-11/20/13 Time: Morning <br /> (Please allow 10 business days from date of application submittal "Tentative only-must be confirmed) <br /> ❑ CHECK BOX T 0 EXPEDITE�EOU8 T 125 FEE(CASH OR CHECK O LY)- REQUEST PROCESSED IN 3 B U&NESS LAYS <br /> SIGNATURE OF APPLICANT j"ry ,��r., �) DATE 11/05/13 <br /> Electronic Information: ❑ Lisp❑ P��Clescrip3tion: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# l Street Name i City ❑ Unit 1 <br /> I <br /> 1. 2216 East Stewart Street I Stockton <br /> 2. <br /> --------- ---�--------------?/� --- --------------- - — - --—El Unit 2- <br /> 3• i <br /> 4' r i/Jnit 3 IL <br /> 7113 <br /> -................................................. ...............................................----.--..........._.._............................-............................._...-------------------.........._........ <br /> 6. }it 4 <br /> 7. <br /> ILhI l3 <br /> $ i Unit 5 <br /> 9. <br /> ..................................._... ........._......................_......-............................................ <br /> ._......._....._...................._......_...._... ...._................... <br /> 113. <br /> ❑Unit 6 <br /> Specific Date flange of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) [I HOUSING ABATE10ENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(r0ONIT0R€NG1RE€:101.1AL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTE/HAZARDOUS MATERIALS E]MOrTEL1HOTEL ❑PUMPER TRUCK/YARD1CHEh1ICAL TOILETS <br /> ❑TIERED PERNUTTED FACILITY f POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING `p COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> VVELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 3:00 APA-5:00PFA (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 /> boxes). At_least one file type MUST be selected. Fax to(209)484-0138 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(14) <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 ne:5a application may be <br /> submitted when the file is available. <br /> 4. Any fife not returned in the same condition as released will be reorganized by EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit: prior to review. SOXIED AREA-EHD USE ONLY <br /> Re c e i v e d 5, '�,2 013(1 2: 12 PWP& 4441szaff Na c. <br /> eao as-as f�,s T <br />