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DATE RECEIVED � ,._ ,, EHD LOG NUMBE <br /> l. SAN JOAQUIN COUNTY <br /> : Lo <br /> �y '"`'�` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, <br /> ,�� 3� ����� CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> F_N I gEN7'ALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/5 au San <br /> APPLICANT: BUSINESS/AGENCY: Partner Engineering & Science <br /> ADDRESS: 400 2nd Street, Suite 415 CITY/STATE/ZIP:San Francisco, CA 94107 <br /> PHONE (1): 415-373-6317 PHONE(2): FACSIMILE:415-889-6020 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE R 122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 11/29/11 <br /> Electronic Information: ❑ List ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street k Street Name City _ ❑Unit 1 <br /> 1. _ 1234 West Charter Way Stockton _I CZ,� I ES <br /> t 2. <br /> 1 3 - -- — --� -- ��-Lnit 2 f <br /> 6 <br /> r77. <br /> / nit 3 <br /> , u <br /> ,{�unit 4 <br /> 8. <br /> — —__ ❑Unit 5 <br /> 9. <br /> 1 nit 6 <br /> Specific Date Range of Information Requested: From All to l <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES (�� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL DAIRY v' L <br /> HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH WASTEWATER TREATMENT PLANT 1 <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> .MEDICAL WASTE FACILITY ❑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-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$122 deposit prior to review. <br /> E DUSE ONLY ons <br /> EHO 49-06 07/29/10 <br />