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�j <br />RECEIVED <br />SAN J OA Q U l N��� � ; 20 Environmental Health Department <br />------- COU N T Y -- PUBLIC RECORDS RELEASE APPLICATION <br />t3 ;' c,, o t ri e- s s � r a w 3 h fE?/li�t3NAEd+iT '�- <br />F'!E~MMS "BY EMAIL `T•VV//' <br />EHD LOG NUMBER: <br />APPLICANT: Dariush Dastmalchi <br />BUSINESS/AGENCY: TMC <br />ADDRESS: 2415 San Ramon Valley Blvd 4-306 CITY/STATE/ZIP: San Ramon, CA 94583 <br />PHONE (1): 925-353-3824 PHONE (2): FAX OR E-MAIL: dariushd@trangt.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 />SIGNATURE OF APPLICANT Dariush Dastmalctli DATE 6/20/2018 <br />1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br />list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138, mail to the <br />address indicated below, or email to info(a)sicehd.com. Applications received after 3:00 pm will be processed the next <br />business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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. 6/)_j4. 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 $152 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 />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES(Specific <br />addresses <br />only, address ranges will not <br />be accepted) <br />EHD USE ONLY <br />IN Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />1 <br />8830 <br />W. Linne Road <br />Tracy <br />s'k,, H#A KtV <br />— ❑ CONSUMER <br />prtas��o 1-4W- . <br />Cleanup Site (LOP) <br />Other Cleanup Site (Non -LOP) <br />Hazardous Waste <br />(W 53`t).7,19 - tk h— ❑ DAIRY <br />F] Tiered Permitted Facility <br />IN Aboveground Tank <br />YA <br />2 <br />8872 <br />W. Linne Road <br />Tracy <br />tAK Rik- <br />QQ��/�� .Yr11 (� ,,((�� ✓ <br />FIZO-G ww&v �—PST— aT <br />❑ PWS <br />UST (Monitoring / Removal) <br />�] Hazardous Materials <br />3 <br />® Spill / Release Response <br />4 <br />WATER QUALITY <br />Solid Waste Facility / Vehicle <br />Food Facility <br />ITE MITIGATION <br />Pool / Spa <br />❑ Dairy <br />5 <br />❑ Land Use Application Sites <br />6 <br />❑ HOUSING <br />❑ Septic Pumper Truck / <br />Yard / Chemical Toilets <br />® Wastewater Treatment Plant <br />CUPA <br />Housing Abatement <br />7 <br />AST/HM / HW <br />❑ Motel/Hotel <br />CUPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />❑ Tattoo/Body Piercing <br />❑ SOLID WASTE <br />❑ Waste Tire <br />9 <br />Complaint <br />❑ Other (Please Specify): <br />❑ ACCOUNTING <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />• _h - f ♦gyp ° _ _' N � ,% <br />,`��' Ilc 1i 1. '•r'�-[Ih�� Y. t, `� t"t- s\ vi �r-et'-� vt (,,�v� � 4'ti� t. '-t t- [� {==-�--.. <br />-- 4- Cp <br />❑ Records provided by Staff -PPR Complete. staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />