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• EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> U , ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205 6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 5j- 0 I'11rii` <br /> 1�71'� PUBLIC RECORDS RELEASE APPLICATION <br /> Jennifer Botelho BUSINESS/AGENCY: ENGEO Inc <br /> APPLICANT: Ri on, CA 95366 <br /> ADDRESS: 580 N. Wilma, Ste. A CITY/STATEIZIP: P <br /> 925-525-4421 PHONE(2): 925-866-9000 FACSIMILE: 888-279-2698 '— <br /> PHONE (1)- Time: e <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑X CHECK BOX TO EXPEDITE REQUEST-$ F E(C S OR CHECK ONLY)-REQUEST PROCESSED I 3 BUSB/ IIN4ESS DAYS <br /> DATESIGNATURE OF APPLICANT W <br /> Electronic Information: [I List❑ Map-Description: J <br /> EHD USE ONLY LAM <br /> Street <br /> ADDRESS <br /> Street# <br /> Street Name CItY ❑Unit 1 <br /> 1 24550 S.Hansen Road Tracy <br /> ❑ Unit <br /> 2.3. j <br /> 4 't 3 <br /> . <br /> 5. nit4 <br /> 6. YYY Y <br /> 7. <br /> ❑Unit 5 <br /> 8. <br /> 9. <br /> ❑Unit 6 <br /> 10. to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNEHICLE <br /> ❑X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY E]SOLID <br /> TIRE <br /> ®OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑ <br /> ❑DAIRY <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) O FOOD FACILITY <br /> CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> ®ABOVEGROUND TANK PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑ <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <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 <br /> in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> Adres <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated <br /> a ooceiveddafters <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications <br /> 3:00 pm will be processed the next business day. ten <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed a. Appointments (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App <br /> should be scheduled accordingly. may be <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application Y <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 atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. "'BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: 914 2 <br /> EHD 48-05 <br />