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01/15/2010 15: 00 7145084401 GOLDER ASSOCIATFS PAGE 01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> �I-,�,MO <br /> SAN .10AQUIN COUNTY <br /> R° IEC�I�� IENVIRONMENTAL HEAETN DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> JAN 1 5 �OIOTelephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjg <br /> E 'V I- N [�HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ���I Vr/SE <br /> A ANT: BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1): PHONE(2). FACSIMILE:���_Sdg <br /> TENTATIVE"APPOINTMENT DATE: Time:_ <br /> (Please allow 10 business days from date of application'submittal-'Tentative only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT RATE_ ( 1S <br /> Electronic Information: ❑ List ❑ Map–Descriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> F-i � �� _� , Logi S��Q�L'ty�.- -- G� F-10--_1 <br /> Unit 1 <br /> 2. _. _ <br /> 3 - __ Unit 2 <br /> 4. <br /> 5 Unit 3 <br /> fi. <br /> 7nit 4 <br /> 8. <br /> 9 ❑Unit 5 <br /> it B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILMYIVEHICLE lv 1?_�, 11 <br /> THER CLEANUP SITE(NON-LOP) IRfFOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) ❑DOG KENNEL JDAiRy 3 <br /> HAZARDOUS WASTE GENERATOR []CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ..TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILE <br /> 9 D TATTOOIBODY PIERCING ❑POOLISPA .AND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑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 un W ten_addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. FaX 09 464-0130 or mailaddre dlcated 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 $115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EMD USt;ONLY <br /> 9 — <br /> EHD 48.1)6 <br /> 8127109 <br />