Laserfiche WebLink
.� <br /> :M3-579-2225 CardnoATC 10:50:72 12-22-2015 1 /2 <br /> wn �. JAN JOAQUIN COUNTY <br /> an ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> DEC 22 2015 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd V <br /> OIRON MENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION � <br /> PEP,,MI11 c V:,-, <br /> APPLICANT: John Sellman BUSINESS/AGENCY: ATC Group Services LLC <br /> ADDRESS: 1117 Lone Palm Avenue, Suite B CITY/STATE/ZIP: Modesto, CA 95351 <br /> PHONE (1): 209-579-2221 PHONE (2): 209-872-5291 FAX OR E-MAIL:john.sellman@cardno.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK 90XT0 EXPEDITE REQUEST-$130 FEE;(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 1 PN: 066-0 0-42 on Rio Blanco Rd. south of Eight Mile Rd., Stock on <br /> 2. O ❑ umtl <br /> 3. �') J PQ0 C7aAJCO l�vl IV `� ❑Unit2 <br /> I <br /> 4. <br /> ❑Unit 2H <br /> 5. 03'unit 3 <br /> 6. p��Ly ulJnit 3HM <br /> 2-(Jnit 4 <br /> B' (SITE MITIGATION <br /> 9. <br /> 10 ❑Unit 5 <br /> Specific Dale Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [S- UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Elm 61TEUH0TEL ❑SOLID WASTE FACILITYNEHICLE <br /> ❑X OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> ❑X ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 0 HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 0 HAZARDOUS MATERIALS ❑TATTOO/BOOP PIERCING ❑LAND USE APPLICATION SITES <br /> ❑2 TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 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)464-0136 or mail to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in Identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 buslness days for review. Appointments <br /> should be scheduled accordingly. <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$130 deposit prior to review. <br /> "`BOXED AREA-EHD USE ONLY" <br /> I <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Time—Dec, 22. -2015-10: 58AM—No. 0239 <br />