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■--4U0/LUl/ lU:UO AI" I 1`f 1Jy5Ly4z1 ➢ 1LUy464U1 iU © 1 <br />ECEWEDSAN JOAOUIN COUNTY EHD LOG NUMBER <br />_MA -ft ENVIRONMENTAL HEALTH DEPARTMENT" � � VV <br />W 0 11 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �. <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov, r h <br />W1%0NM.�TAL � ' <br />IL <br />F'EFIIlalrfi/t;E <br />T s E <br />S <br />PUBLIC RECORDS RELEASE APPLICATIO t <br />APPLICANT: David Gerhardstein BUSINESS/AGENCY: Partner ESI <br />ADDRESS: 11i Fine St, STE 1.750 CITY/STATE/ZIP: San Francisco, CA 94111 <br />PHONE (1): 415-599.1184 PHONE (2): FAX OR E-MAIL: ___ <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. D <br />O' GNEGi< BOX TO EXPEDITE REQl7EST $:1 0 FEE (CASH 019 CHECK ONLY):FIE QUEST PR IGESSED.IN 3 BUSiNE. S GAYS <br />SIGNATURE OF APPLICANT dgerbardstein@partneres-*L.com DATE May 8, 201 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />— <br />EHD USE ONLY <br />Street # <br />_ _ <br />Street Name City _ <br />1 <br />2070`0 <br />(lolly Drrj,ve Tracy <br />,''p <br />� � (.i. A _4A�7 <br />UU�W LSt C"l��r U� <br />2.i <br />114M <br />3. <br /><� _ r <br />I <br />4.+ <br />P 4" <br />CqA-iiw/rt <br />5. <br />6. <br />7. <br />i- <br />8. <br />2"S MITIGATION <br />9. <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL. HEALTH DEPA T,M.ENT;FILES <br />Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOTEL/HOTEL E❑ SOLID WASTE FACILITYNEHICLE <br />© OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ FOOD FACILITY <br />Q UNDERGROUND TANK (MONITORING/REMOVAL) ® WASTE TIRE ❑ DAIRY, POOLISPA <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL © WASTEWATER TREATMENT PLANT <br />x-1 HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />Q HAZARDOUS MATERIALS ❑ TATTOO/BODY PIERCING ❑ LAND USE APPLICATION SITES <br />0 TIERED PERMITTED FACILITY COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00AM .IGPMEXCLUDING 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) 464-0136 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 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 $130 deposit prior to review. <br />*'*BOXED AREA - EHD USE ONLY*** <br />