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DATE RECEIVED EHD LOG NUMBER <br />0(011 <br />50SAN JOAQUIN COUNTY <br />cENVIRONMENTAL HEALTH DEPARTMENT <br />V1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />I li Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />161 <br />APPLICANT: Heather Nilson <br />BUSINESS/AGENCY: Andersen EnVir0171ental <br />ADDRESS: 5261 West Imperial Highway "CITY/STATE/ZIP: Los Angeles, CA 90045 <br />PHONE (1): 310-854-6300 <br />PHONE (2): <br />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 <br />DATE 2/10/2015 <br />Electronic Information: <br />❑ List ❑ Map —Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name City <br />1. <br />2-48(even) <br />W. Weber Ave. <br />Stockton <br />�r"'ti� <br />IVf'(= <br />r' <br />❑ Unit <br />2. <br />21-47(odd) <br />N. Center St. Stockton <br />3. <br />33-47(odd) <br />W. Main St. <br />Stockton <br />N� t- <br />NII— <br />❑ u it 3 <br />4. <br />2-48(even) <br />N. Commerce St. Stockton <br />I I i ,,,, ,, <br />.(]'Chit 4 <br />6'A' <br />i I i i u7 .( �• <br />7. <br />> <br />0, <br />�ile5 1 <br />❑ Unit 5 <br />8. <br />). <br />(' ' v1 7 l(%"r n '"3f?�L /.^ .�, <br />9. <br />ks <br />❑ Unit <br />10. <br />71' <br />Specific Date Range of Information Requested: From Earliest L ; to Present <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑■ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <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 />Q HAZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ 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:OOPM (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 $130 deposit prior to review. 'BOXED AREA - EHD USE ONLY - <br />1 ❑ Records provided by Staff -PPR Complete. Staff Name: <br />