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0 W EHD LOG NUMBER <br /> DATE RECEIVED �1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � <br /> Hazelton Avenue 1868 past H , Stockton, CA 95205-6232 <br /> ti (v f °Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Harris& Lee Environmental <br /> APPLICANT:Cathy Neumann BUSINESS/AGENCY:Sciences, LLC <br /> ADDRESS: 120 Ross Valley Drive CITY/STATE/ZIP:San Rafael, CA 94901 <br /> PHONE (1): 415-237-0303 PHONE (2):415-531-2921 FACSIMILE:1-866-873-4361 <br /> TENTATIVE*APPOINTMENT DATE: As soon as possible Time: Morning preferred <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ST-$125 FEE(CASH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List El Map–Description: <br /> FILE ADDRESS S — EHD USE ONLY <br /> Street# Street Name — City ElUnit 1 <br /> East Woodbridge Road(APNs:013-220- Acampo <br /> 1. 3750 06,-07&-52) <br /> 2. -- ---�— 0 Unit 2 <br /> 3. ---....------- <br /> -4. --- --- --- ----- --- -- --- __. --- _ 0 Unita 'e� <br /> -- --- <br /> �.�------------�-- --- ------------ ��/� C � Cam <br /> _❑Unit 4 <br /> 7. ----- ----- <br /> 8. 0 Unit 5 <br /> 9. <br /> ---------------- <br /> 1 ❑Unit 6 <br /> Specific Date Range of Information Requested: From all records available to present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ©HAZARDOUS WASTE GENERATOR_ ❑CHICKEN RANCH ❑WASTEWATERTREAIMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHENIICAL TOILETS <br /> `❑TAT T OOIBODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> ❑ IIrEDICAL WASTE FACILITY ©COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select thetype(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 deposit prior to review. <br />