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From:Amy Kerstiens Fax'+1(877)623-5493 . T:: Fax: +1 (209)464-0138 Wage2 of 2 3/281201210:01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .1OAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> MAit 2 8 2012 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwwv.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> _PERMIT/SERVicEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Any Kerstiens BUSINESS/AGENCY:Endro Assess <br /> ADDRESS: PO BOX 1154 CITY/STATE/ZIP:Boners Ferry,ID 83805 <br /> PHONE (1): 877-629.6838 PHONE (2):2DB-946.4195 FACSIMILE:877.623-5493 <br /> TENTA T/VE*APPOINTMENT DATE: April 9,2012 Time: 9:00 am <br /> ` _ (Please allow 10 business days from date of application submittal.7entatr've only-must be confirmed) <br /> 1L�{;HECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Amy Kerstiens -- DATE March ze,2012 <br /> Electronic Information: 0 List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name _ City <br /> L 678 N. Wilson Way Stockton Gj-:T I�kA11 I 5 19 1 <br /> Unit 2 <br /> 3. q <br /> 4. " Irl'Unit 3 <br /> 5. <br /> 6. unit4 ` w <br /> 7. <br /> a. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6-1 <br /> Specific Date Range of Information Requested: From 1940 to present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) y ❑FOOD FACILITY ❑WASTE TIRE t ,^U� z <br /> Q UNDERGROUND TANK(MONITORING REMOVAL) [:1 DOG KENNEL El DAIRY W'I4 <br /> []HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA ❑LAND USE APPUCATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMS: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 mall 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 flies 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 EHO 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 $125 deposit prior to review. <br /> lop , o - d qJ° <br /> HD 48-06 ZIS <br /> y-z-rz: ®�©o►earl a GP�`� �f the its �M,�l . �ks <br />