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`DATE RECEIVED SAN JOAQ EHD LOG NUMBER <br /> C�` Y ENVIRONMENTAL HRAREPARTMENT <br /> � 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ( � Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Tina Cheney/ Geno Olson BUSINESS/AGENCY: Neil O.Anderson &Associates <br /> ADDRESS: 902 Industrial Way CITYISTATE/ZIP: <br /> PHONE (1): 209-747-0640 -Tina PHONE (2):209-367-628-1898-Geno FACSIMILE:209-333-8303 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> X CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Tina Cheney—digital signature—ok to expedite DATE November 30,2012 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1443 yNavy Drive Y r ; I�� pCT�I Stockton <br /> 2. <br /> 7,1,(-'b Navy Drive Stockton ❑unit 2 <br /> 4. 1023 Pershing Ave Stockton 6nit 3 I <br /> 6. 1415 Anderson St. Iv Stockton 2 'CJunit4 <br /> 7. <br /> 8 , ❑Unit 5 <br /> 9. r <br /> 10. .{]Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY X SOLID WASTE FACILDYNEHICLE <br /> X OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> X UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> XABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL, ❑WASTEWATER TREATMENT PLANT <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> X TIERED PERMITTED FACILITY ❑POOUSPA ❑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-6:00PM(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$125 de sit prior to review. ;`^'BOXED AREA__EHD USE ONLY <br /> i <br /> 11 Records provided by Staff-PPR Complete. Staff Name: <br />