Laserfiche WebLink
_ - D l5- £CFIVED— In <br /> - EHD LOG NUMBER <br /> ((D EC- Da ENVIRONMENTAL HEATH DEPARTMENT <br /> ln� ARTM ENT <br /> 800 East Main Street, Stockton, CA 95202-3029 <br /> MAP 2, 6 Z1109 Telephone: (209) 488-3420 Fax: (2D9) 464-0138 Web: wwvv.sjgov.org z <br /> ENWMMf HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ` t [Cerran Pnnder <br /> APPLICANT: _------ �— —_ _— ----BUSINESS/AGENCY: Partner Engineering and Science <br /> g <br /> ADDRESS: 2101 Rosecrans Ave, 44276 E1 Segundo, CA 90245 <br /> -- —_-- —_— _— City/State/Zip --- _ <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-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Kerran Pender DATE 3/2s/o9 <br /> Electronic Information: <br /> ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name 7TracTeyy <br /> Unit 1 <br /> 1, 3776 West Grant Line Road <br /> ]7 <br /> 2. A- NGYJ03 . <br /> .� <br /> 3. fl/ <br /> :, . <br /> 4 A de It 3 <br /> 5. <br /> 6 Unit 4 <br /> 7. off <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT M SOLID WASTE FACILITYIVEHICLE <br /> M OTHER CLEANUP SITE(NDN-LOP) ❑ FOOD FACILITY Q WASTE TIRE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR d CHICKEN RANCH 121 WASTEWATER TREATMENT PLANT <br /> I$TIERED PERMITTED FACILITY In MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ PoOLISPA [TLAND U5E APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RE1AEw- 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 209 454-0138 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 /> I 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 $105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8I04/CB PUBLIC RECORDS RELEASE APP FORM <br />