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it F <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY � <br /> ` l <br /> ir< < � ��- ENVIRONMENTAL HEALTH DEPARTMENT <br /> f` I 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> )_:? Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov, org/ehd <br /> Uri <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Nicole Persaud BUSINESSIAGENCY: Antea Group <br /> ADDRESS: 1155 N . 1st Street , Suite 201 CITYISTATEIZIP: San Jose , CA 95112 <br /> PHONE (1 )0 407 - 758 - 3428 PHONE (2): FACSIMILE. 925 - 886 - 8830 <br /> TENTATIVE" APPOINTMENT DATE: 6 / 28 / 13 Time: 1 : 0 Opm <br /> (Please allow 10 business days from date of appticafon submittal -'TaafaSve only- must be confirmed) <br /> O CHECK BOXTO EXPEDITE REQUEST - $125 EE (C. HOR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6 / 13 / 13 <br /> Electronic Information: ❑ List © Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit <br /> 1 . 10476 Linne Road Tracy <br /> 2. 3�2.'�' ❑ Unit 2 <br /> 3. <br /> 4. Beloit 3 <br /> 6. ! Elunit 4 <br /> &. ❑ Unit 5 <br /> 9. <br /> ION [] Units <br /> Specifc Date Range of Information Requested: From Earliest available date to Present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NUNDERGROUNOTANK (USTI CLEANUP SITE (LOP) ❑ MEDICALWASTEFAcIUTY © SOUD WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE (Nom-LOP) ❑ HOUSING ABATEMENT F] WASTE TIRE <br /> ® UNDERGROUNOTANK (MONITORINGWMOVAL) ❑ FOODFACILITV Q DAIRY <br /> rWry ABOVEGROUND TANK ❑ CHICKEN RANCHIDOGKENNEL Q WASTEWATERTREATMENT PLANT <br /> u HAZAROQUSWASTEIHAZARDOUS MATERIALS EIMOTELMOTEL © PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 0 TIERED PERMITTED FACILITY ❑ POOLISPA © LAND USEAPPLICATION SITES <br /> ❑ TATTOO/BODY PIERCING N CoMPLAINTMESPONSERECOROS ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM (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) 484-0138 or mail tot�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 END 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. Anew application maybe <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 toreview. aBQXED AREA - EHD USE ONLY <br /> Records provided by Staff-PPR Complete. staff Name: <br /> EHe 18-86 91dHE <br />