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rG �A EHD LOG NUMBER <br /> ( 0 SAN JOAQUIN COUNTY <br /> MAY 0 4 20V ENVIRONMENTAL HEALTH DEPARTMENT 86085 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEAjI#phone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.com Email: infoOsicehd com <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> �1PPLICANT: Alisha C Pember BUS_INESS/AGENCY: Adams Broadwell Joseph <br /> ADDRESS: 601 Gateway Blvd Ste 1000 CITY/STATE/ZIP: South San Francisco, CA 94080 <br /> PHONE(1): 650-589-1660 ext 24 PHONE (2): FAX OR E-MAIL: apemberlrDaaamsCroatlwellcnm <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 REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by Staff. Dom M DATE May 4 2017 <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 list <br /> 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 above, or email to info()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 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 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$139 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 /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) S Hwy 99 ®CONSUMER <br /> ®OTHER CLEANUP SITE(NON-LOP 12001 Manteca <br /> (Delicato Vineyards) <br /> ®HAZARDOUS WASTE <br /> ®®TIERED PERMITTED FACILITY 2 DAIRY <br /> ®ABOVEGROUND TANK <br /> ®UST (MONITORING I REMOVAL) ®PWS <br /> ®HAZARDOUS MATERIALS 3 <br /> ®SPILLIRELEASE RESPONSE <br /> ®SOLID WASTE FACILITYI VEHICLE 4 ®WATER QUALITY <br /> ®FOOD FACILITY <br /> ®POOL/SPA ®SITE MITGA71ON <br /> ®DAIRY S <br /> ®LAND USE APPLICATION SITES �•�N.0 '+' `+ �� <br /> ®SEPTIC PUMPER TRUCK/ B ®HOUSING <br /> YARD I CHEMICAL TOILETS <br /> ®WASTEWATER TREATMENT PLANT ®CUPA <br /> ®HOUSING ABATEMENT 7 <br /> ®MOTELIHOTEL <br /> ®CHICKEN RANCH I DOG KENNEL ®CUPA-UST <br /> e <br /> ®MEDICAL WASTE FACILITY <br /> ®TATTOOIBODY PIERCING <br /> ®WASTE TIRE S ®SOLID WASTE <br /> ®COMPLAINT <br /> ®OTHER(PLEASE SPECIFY): ❑ACWUNDNG <br /> IlWell&Septic 'D <br /> '—EIOXED AREA-EHD USE ONLY— <br /> O DD <br /> n <br /> ��` <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: G <br />