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EHD LOG NUMBER _ <br /> In' SAN JOA0WC&UNTY <br /> � 1�t� t�v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> MAP, 2 0 N09 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org Z <br /> Z <br /> ElVV30NN (u ���� PUBLIC RECORDS RELEASE APPLICATION <br /> Kerran Pander En ineerin <br /> APPLICANT: Partner—_ -- —_—`---_----------BUSINESSIAGENCY: _-- 9 9 and Science <br /> 2101 Rosecrans Ave, #4270 E1 Segundo, CA 90245 <br /> ADDRESS: --------_�— --_---- — CItylState/Zip ---g_ -- — _-- <br /> PHONE(1): _415-962-4755 ------ PHONE(2): 917_710-2770 —FAGSEMILE: 1-800-419-4923--- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be co rm dUA 1pqy <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN <br /> SIGNATURE OF APPLICANT Kerran Pander DATE 3/25/09 <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City <br /> ❑ Unit 1 <br /> 1. 3776 West Grant Line Road Tracey <br /> 2. ft.�Eq <br /> 3. <br /> 4. Unit 3 <br /> I <br /> 5. <br /> l;. Unit 4 <br /> 7. <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 /> E M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ®SOLID WASTE FACILITYIVEHICLE <br /> M OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL CI DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH a WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOOIBODYPIERCING ❑ PoOLISPA 0'LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to fen 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)484-0138 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 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 8104108 PUBLIC RECORDS RELEASE APP FORM <br />