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EHD LOG NUMBER <br /> DATE RECEIVED • SAN JOAQUIN COUNTY <br /> a Iq <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or d <br /> 7e65q <br /> ♦/ 0 0! <br /> .. . <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 /> /Staff 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 <br /> SI NATURE OF APPLICANT DATE_ g�/�J <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 1 Unit 1 <br /> 1. ,212 Industrial Drive Stockton ` r A <br /> 2. 248 Industrial Drive Stockton 04, LO c,y nit 2 <br /> 3. <br /> 4. / Unit 36. I <br /> (UdUnit 4 <br /> 7. <br /> 8. <br /> rl Unit 5 <br /> 9. <br /> 10. <br /> El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICC�E )) S <br /> ©OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL)�,r ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUSWASTEIHAZARDOUSMATER/ALS- ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY 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 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 /> r y <br /> �{- - M GU n s I L d- ct�0 r r 5 <br /> i A i ,0i 16i t (12-2.3 y 3 0, oo r,5 <br /> 0 Records i EHD 48-08 717 -71o(­ ;f;ne (�'��) 4128114 <br />