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�pp�gT �&fiEIy,FUE r, EHD LOG NUMBER <br /> E �' SAN �1OAOUiN COUNT`( <br /> ENVIRONILiENTAL HEALTH DEPARTMENT <br /> DEC 0 9 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> _NvIRONr.aENTALwEALTIt PUBLIC RECORDS RELEASE APPLICATION <br /> PERM i i"%CFRVlCES <br /> APPLICANT: Benjamin Berman BUSINESS/AGENCY: IRC Environmental <br /> ADDRESS: 430 South Fourth Street CITYISTATEIZIP: San Jose, CA 95112 <br /> PHONE (1): (408) 313 - 9376 PHONE (2): FAX OR E-MAIL:ircenvironmental@gmail.cori <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 REQUE T.S130 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT :, t'l, )-- DATE 12-09-2015 <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street 9 Street Name City <br /> 4965 - �'Ajf 99,E.Frontage Rd Stockton NI'� <br /> 2• 4943 119,E.Frontage R Stockton �/ �� nit_5 <br /> 3 4489 99,E.Frontage Rd Stockton ®�init <br /> 4. 5332tl�9 Fron age Road Stockton N ❑Unit 2H <br /> 5• 5334 4499 Frontage Road Stockton t4?r- Unit 3 <br /> 6, 5336 ` Ioi99 Frontage Road Stockton r p Unit 3HM <br /> 7• 5338 VW199 Frontage Road Stockton Isildnit 4 <br /> B. Q�SITE MITIGATION <br /> S. ov <br /> 10' 2 21 'J UY� units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEUHOTEL OLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT MOOD FACILfTY <br /> UNDERGROUND TANK(MONITORINGIRmOVAL) ❑WASTETIRE 00AIRY,POOLISPA <br /> MABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> IF54AZARDOUS WASTE MEDICAL WASTE FACILITY `PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS TATTOOIBODY PIERCING ;LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MOHDAY-FRIDAY 8:00 AM-5:00Pht(EXCLUDING HOLIDAYS) _ <br /> 1. List up to ten addresses In the space above. Select the type(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.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 flies 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 expanse of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. <br /> "`BOXED AREA-EHD USE ONLY"` <br /> MNIKU I <br /> amd '1101311� <br /> 0 Records provided by Staff-PPR Complete, Staff Name: <br />