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RECEIVED <br />SAN J OAQ U 1 N JUIN it 4 2038 Environmental Health Department <br />- C OU N TY------- PUPLIC RECORDS RELEASE APPLICATION <br />F.b� RONLWX;rAL 11-11PPM (ZOO <br />• PEnwri mAtEs �- AN1 EHD LOG NUMBER: �!l V <br />APPLICANT: Bailey BalShor BUSINESS/AGENCY: Partner Engineering and Science, Inc <br />ADDRESS: 1544 Eureka Road, Suite 180 CITY/STATE/ZIP: Roseville, CA 95661 <br />PHONE (1): 916-823-7555 PHONE (2): FAX OR E-MAIL: BBalshor(d_)partneresi.Com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact, yov to afrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT I )� /IidT /� DATE 5-31-2018 <br />1. List up to ten addresses in the spaFe 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(cDslcehd.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. <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 />Ll <br />�j <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />FILE ADDRESS <br />only, address ranges will not <br />y 9 <br />be acce ted <br />accepted) <br />AL <br />EHD USE ONLY <br />❑X Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />' <br />1422 <br />West Colony Road <br />Ripon 11M <br />T5 IIAyZ GID'm []CONSUMER <br />\J� <br />�Ro-may _ Wh_ GL <br />X Cleanup Site (LOP) <br />® Other Cleanup Site (Non -LOP) <br />® Hazardous Waste <br />® Tiered Permitted Facility <br />Q Aboveground Tank <br />2 <br />1442 <br />West Colony Road <br />Ripon <br />N Ripon'_ v15 <br />� ❑DAIRY <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 />SITE MITIGATION <br />❑ Pool / Spa <br />R Dairy <br />5 <br />❑ Land Use Application Sites <br />6 <br />❑ HOUSING <br />❑ Septic Pumper Truck / <br />Yard / Chemical Toilets <br />F] Wastewater Treatment Plant <br />(CUIA <br />❑ Housing Abatement <br />7 <br />AST I HM / HW <br />❑ Motel/Hotel <br />gGLIPA <br />F1 Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />Tattoo/Body Piercing <br />Waste Tire <br />s <br />❑ SOLID WASTE <br />Fj Complaint <br />Other (Please Specify): <br />10 <br />❑ ACCOUNTING <br />'BOXED AREA - EHD USE ONLY— <br />(;'t'(-i'tj' " r-u.,(l C C vnj-,�',�, l�i.� t L;� �+ , . �,; . .-�a ;:,1 � c��.,,, ur\ t� InIi,V2.. �-t I •. <br />71 f <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />