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-RIECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT olib <br />SEP 2 2 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />WRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />Tpq�W"Molomon BUSINESS/AGENCY: Phase -1 Environmental Services <br />ADDRESS: 5216 Harwood Rd <br />PHONE (1): <br />CITY/STATE/ZIP: San Jose, CA 95124 <br />408-406-0833 PHONE (2): FAX OR E-MAIL: chris@phase-lenvironmental.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 BOX TO EXPEDITE REQUEST- $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Christopher G Solomon DATE 09/22/2016 <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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. 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 business 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FILE ADDRESS <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />385 <br />West Grant Line Rd <br />Tracy <br />j �_ 71'� `/♦, ❑ CONSUMER <br />/ / /•T/cl& <br />CLEANUP SITE (LOP) <br />FVj OTHER CLEANUP SITE (NON -LOP) <br />lV HAZARDOUS WASTE <br />11 DAIRY <br />rVj TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />❑ PWS <br />UST (MONITORING/ REMOVAL) <br />0 HAZARDOUS MATERIALS <br />3 <br />F✓ SPILURELEASE RESPONSE <br />F1 SOLID WASTE FACILITY / VEHICLE <br />FOOD FACILITY <br />4 <br />WATER QUALITY <br />1 1 1 ) <br />V I I 1 wi (a <br />NSITE MITIGATION <br />F-1 POOL/SPA' <br />F1 DAIRY <br />5 <br />I] LAND USE APPLICATION SITES <br />6 <br />❑ HOUSING <br />F-] SEPTIC PUMPER TRUCK/ <br />YARD / CHEMICAL TOILETS <br />❑ WASTEWATER TREATMENT PLANT <br />Cee PA <br />L_1 <br />❑ HOUSING ABATEMENT <br />7 <br />F1 MOTELIHOTEL <br />CHICKEN RANCH / DOG KENNEL <br />9KCUPA - UST <br />MEDICAL WASTE FACILITY <br />8 <br />TATTOO/BODY PIERCING <br />WASTE TIRE <br />COMPLAINT <br />9 <br />❑SOLID WASTE <br />F� OTHER(PLEASE SPECIFY): <br />❑ ACCOUNTING <br />10 <br />"'BOXED AREA - EHD USE ONLY"' <br />