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i <br /> SAN JOAQUIN COUNTY 10 EHD LOG NUMBE <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 3 1 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIROWENT HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:vvvvw.sjgov.org/e <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> er <br /> Kerran Pender Partner Engineering d Science <br /> APPLICANT: � ___BUSINESSIAGENCY: _ 9 9 an_- <br /> ADDRESS: 2101 Rosecrans Ave, #4270 City/State/Zip El Segundo, CA 90245 <br /> PHONE(1): 415_962-4755 _ PHONE(2): 917-710-2770 FACSIMILE: 1-800-419-4923 <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 REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Kerran Pender DATE 3/25/09 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> _ _ Streel# Street Name City '-A <br /> Unit 1 <br /> 1. 140 Lathrop Road Lathrop J y <br /> El <br /> 2. Unil Z <br /> N 3. <br /> '�✓ 4. Uni[3 <br /> 5. <br /> s. nil 4 <br /> 7 ❑ Unit 5 <br /> 6. <br /> 9. Unil 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILITYNEHICLE <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY B WASTE TIRE J t• •/ <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL)tt4 ❑DOG KENNEL ❑DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR K ❑CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT lMl .7 <br /> 12 TIERED PERMITTED FACILITY oe_ ❑MOTEL/HOTEL ❑PUMPER TRuCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑POOL/SPA U LAND USE APPLICATION SITES IV�AVh -1 (J /-ql <br /> M MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 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 flle addresses,contact the EHD. Applications received after <br /> --- __ --3:00 pm will beprocessed the next busims_s days <br /> 2. The EH D wl11 notify the applicant If any EHD files exist. An appolntme nt for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> - q 52 y n fYUAd I <br /> no dv so <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />