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SAN JOAQU§ECE'VE <br /> nvironmental Health Department <br /> —COUNTY— WR 2 $ 2018PUBLICrRECORDS RELEASE APPLICATION <br /> Greatness Grcws he � »��� <br /> o�lyurrirt� MAIL v <br /> 32 EHD LOG NUMBER: <br /> APPLICANT: semeriltGupta BUSINESSIAGENCY: <br /> ADDRESS: 41364 Mahoney St CITYISTATEIZIP:Fremont,CA,94539 <br /> PHONE(1): 510-396-0003 PHONE(2): FAX OR E-MAIL: semerLgupta@yahm.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 reviewthe requested records. <br /> SIGNATURE OF APPLICANT Semerj"t G2mzt �yyq °a•'""^"°""'""'°° DATE <br /> 1. List up to ten addresses in the space beloig. Addre 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(disicehd.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. <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$152 deposit prior to review. l/ <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 FILE ADDRESS <br /> HEALTH DEPARTMENT ccepted) EHD USE ONLY <br /> FILES (Specific c addresses only,address ranges will not be a <br /> , <br /> ❑x Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ❑CONSUMER <br /> Other Cleanup Site(Non-LOP) <br /> 1206 East March Lane Stockton ' \ 1 <br /> ❑X Hazardous Waste ❑DAim <br /> Q Tiered Permitted Facility 2 n <br /> Q Aboveground Tank Int' I•t H V -T <br /> ❑PWS <br /> R UST (Monitoring I Removal) /x7 <br /> Q Hazardous Materials a <br /> nX Spill Release Response WATen QUP➢tt <br /> Solid Waste Facility/Vehicle 4 ` <br /> Food Facility ^ t <br /> Pool/Spa / ElSITE MITIGATION <br /> Dalry <br /> a <br /> rnoII <br /> Land Use Application Sites 1 e—/ HouslrvG <br /> Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement T AST IHM IHW <br /> MotellHotel <br /> CUPA <br /> Chicken Ranch/Dog Kennel <br /> UST <br /> Medical Waste Facility <br /> n Tattoo/Body Piercing /� Q ❑Souo WASTE <br /> Waste Tire 9 <br /> Complaint <br /> Other(Please Specify): <br /> to C]AOoouNnNG <br /> Iwo ' p <br /> � —BOXED AREA-EHD USE ONLY** r <br /> 10 'k ` n. ` '�WrA o� 1 r ,rt-ei it M.� ('l C W 1 o-I, <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48a6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />