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DATE PE.EIVFP - FI ID LOG NUMBER <br /> e SAN JOAQUIN COUNTY <br /> -ENVIRONMENTAL HEALTH DEPA ,TIENT <br /> 600 East Main St. Stockton. CA 9520L-3029 ' <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.$)gov.olg/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Harris & Lee Environmental <br /> APPLICANT: Walter Beach BUSINESS/AGENCY: Sciences, LLC <br /> ADDRESS: P.O. Box 8369 CITY/STATE/ZIP: Santa Rosa, CA 95407 <br /> PHONE (1): 415-287-3007 PHONE (2):415-730-0012 FACSIMILE: 866-873-4361 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> XXXX CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Walter Beach DATE May 2, 2011 <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1 928 Frontage Road(formerly 904 Frontage Ripon <br /> 2 APN 261-020.34(formerly APN 261-020- <br /> 23,24&25) <br /> s a 0 W5 <br /> _ 4- �� - ---- /Unit 3 <br /> 5• <br /> -- - - -- -- <br /> 6. � - — - -------- -- - - -- -Unit 4 [ <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From As far back as possible to Present-May 2011 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT X❑SOLID WASTE FACILITY/VEHICLE <br /> X❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY X❑WASTE TIRE <br /> X❑UNDERGROUND TANK(MONITORING/REMOVAL)CX., <br /> ❑DOG KENNEL ❑DAIRY <br /> X❑HAZARDOUS WASTE GENERATOV, ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> X❑TIERED PERMITTED FACILIPO(, ❑MOTEL/HOTEL ❑PUMPER TRUCKNARO/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES^ <br /> X❑ MEDICAL WASTE FACILITY X[:]OTHER(PLEASE �'.1� (( <br /> SPECIFY) L �G I <br /> *WE ARE DOING A PHASE 1 REPORT AND WOULD LIKE ANY RECORDS RELATED TO HAZARDOUS MATERIALS OR RELEASES OF <br /> CONTAMINANTS. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 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)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$122 deposit prior to review. <br /> EHD USE ONLY <br /> f <br /> M <br /> H 48- 6 07/29110 <br />