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RECEIVED <br />SAN J OAQ U I N Environmental Health Department <br />-- COU N T Y-"il;� IZ��� PUBLIC RECORDS RELEASE APPLICATION <br />LWIROW <br />PERWIT EHD LOG NUMBER: <br />APPLICANT: Rovelle Banzuela <br />ADDRESS: 300 N. Lake Ave. Ste. 400 <br />BUSINESS/AGENCY: Stantec Consulting Services, Inc. <br />C ITY/STATE/ZI P: Pasadena, CA 91101 <br />PHONE (1): 310-408-3678 PHONE (2):626-568-6056 FAX OR E-MAIL: rovelle.banzuela@stantec.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, DATE s 1i=zo,< <br />1. List up to ten addresses in the space belo . 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(cDsicehd.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 19,n to Pe�enl <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES(Specific <br />addresses <br />FILE ADDRESS <br />only,address ranges will not <br />be accepted) <br />l <br />EHDUSEONLY <br />0 Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />1721 <br />W. Yosemite Ave. <br />Manteca <br />LYIYIQ P .�.{� ^/ ❑CONSUMER <br />nO �1 0. l <br />Cleanup Site (LOP) <br />QX Other Cleanup Site (Non -LOP) <br />Q Hazardous Waste <br />Q Tiered Permitted Facility <br />Q Aboveground Tank <br />2 <br />1 LM <br />DAIRY <br />❑ PWS <br />Q UST (Monitoring / Removal) <br />X❑ Hazardous Materials <br />3 <br />nX Spill / Release Response <br />n Solid Waste Facility I Vehicle <br />4 <br />M"WATERQUALITY <br />F] Food Facility <br />SITE MITIGATION <br />El Pool / Spa <br />❑ Dairy <br />6 <br />F1 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 I HM / HW <br />Motel/Hotel <br />COPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />9 <br />UST <br />Tattoo/Body Piercing <br />F] Waste Tire <br />g <br />❑ SOLID WASTE <br />Q Complaint <br />❑ ACCOUNTING <br />Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />t w' �t „ti,e nZC t0 f p f �� . to �e�� t ,�. .i °z i c ir�-� `��--� <br />v . <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 />