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DATE RECEIVEDj EHD LOG NUMBER <br /> f r`' SAN .�OAQUIN COUNTY `e <br /> ENS IRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ` trr ,iJl i Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Robert Anderson BUSINESS/AGENCY: GaiaTech <br /> ADDRESS: 2223 S. Sherman Street CITYISTATE/Zip: Denver, CO 80210 <br /> PHONE (1): 773-620-4197 . PHONE (2): email: randerson@gaiatech.com <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-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Robert Anderson DATE 3/10/14 <br /> Electronic Information: X List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 800 B West Church Street ZsJ,w, Stockton <br /> 2. 2575 Grand Canal Boulevard �% Stockton <br /> 'p unit 2 <br /> 3. A b39 <br /> r <br /> 4. :7 <br /> 5 ,E:l Unit 3 -� <br /> r7. <br /> / <br /> oma- , <br /> li l" -E]Unit <br /> AUL a 0�/ El Unit 5 <br /> 10. <br /> Specific Date Range of Information Requested: From to Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY X SOLID WASTE FACILITYNEHICLE <br /> X OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> IX UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> X ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL X WASTEWATER TREATMENT PLANT <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL U PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> X TIERED PERMITTED FACILITY n POoL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING X 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 /> I. 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$125 deposit prior to review. E*"BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> 9ldN 9 <br />