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07/12/2010 11:37 9168610430 STANTEC PAGE 02/02 <br /> DATE RECEIVE EHD LOG NUMBER, <br /> D ������© COUNTYSAN JOAQUIN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> U1U 600 East Main Street, Stockton, CA 95202-3029 <br /> j1,L 2 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov•org/ehd 4 4o <br /> ENpEghAj4jgF IQE HEALTH RECORDS RELEASE APPLICATION <br /> APPLICANT: Danielle Mantling BUSINESSfAGENCY: Stantec Consulting Corporation <br /> ADDRESS: 3017 Kilgore Road, Suite 100 Cltylsotelzlp Rancho Cordova, CA 95670 <br /> PHONE(1): (916) 384-0706 PHONE(z); (916) 2$1-4942 FACSIMILE: (916) 661-0430 <br /> TENTATIVE'APPOINTMENT DATE: July 20, 2010 Time: 10:00 am <br /> (Please allow 10 business days from date of application submittal-'renfat/ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDIJE UEST-910 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU31NESS DAYS <br /> SIGNATURE OF APPLICANT DATE 791 fCJ <br /> Electronic Information; 0 List Q Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street_9 Street Name City ❑ Unit 1 <br /> 1. 7647 Pacific Avenue Stockton <br /> ❑ Unit 2 <br /> 2. <br /> 3. ..-... ._._—.—.._ unit 3 <br /> 4. <br /> U n h 4 <br /> 7. ___._ ❑ Unit 6 <br /> S. <br /> --......__. ._...... - ... _. <br /> unit S <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> 1985 to Present <br /> ENVIRONMENTAL HEALTH DEPARTMENT T=ILES <br /> HOUSING ABATEMENT C SOLID WASTE FACILITYIVEHIC LE <br /> �UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 WASTE TIRE <br /> ®OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY <br /> m UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> 91 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 91 TIERED PERMITTED FACILITY 0 M07CLIHOTEL CI PUMPER TRUCIUYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING In POOLISPA M LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Il OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6: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 (208)464-0138 or mail to the address indlcated-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 flies 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 flle 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 $106 depo9it prior to review. <br /> EHD USE ONLY <br /> PUBLIC RECORDS RELEASE APP FORM <br /> @HO 48-OB 6104108 <br />