Laserfiche WebLink
NEW03/201/ 10:03 AM 14159529421 )12094640138 <br />rECEIVEPI <br />SAN JOAQUIN COUNTY <br />� , ENVIRONMENTAL HEALTH DEPARTMENT <br />MAY 0 1112017 t y' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />'WR0Nl' J!N'FAL f�.'Fi <br />PEMMIT1SEMA ES ''•' PUBLIC RECORDS RELEASE APPLICATION jj <br />APPLICANT: David Cerhardstein <br />ADDRESS: 11.1 Pine St, STE 1750 <br />EHD LOG NUMBER <br />40terv% <br />BUSINESS/AGENCY: Partner ESI <br />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. <br />❑'GHEGK_BOX TO.XPEpITE REQUEST ..$130 FEE (GASH,OR CHECK,ONLY} =, REQl1EST PRO:EESE7,:IN 3 BUSiNES:pAYS l <br />SIGNATURE OF APPLICANT dgerhardstein@partneres-L.com DATE May 8, 2017 l <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />_ <br />EHD USE ONLY <br />Street if <br />_ <br />Street Name City <br />1' <br />90500 <br />[folly D.ri,ve J Tracy <br />I -j Ln- "�51toQ� <br />2. <br />Ili 7J <br />3. <br />�. <br />4. <br />5. <br />6. <br />d <br />'• <br />+ <br />8. <br />SITE MITIGATION <br />s. <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAt, HEALTH D,EPAftTMENT FILES <br />0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOTEL/HOTEL 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 />❑. HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />0 HAZARDOUS MATERIALS ❑ TATTOO/BODY PIERCING ❑ LAND USE APPLICATION SITES <br />FX TIERED PERMITTED FACILITY Q COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY S:OO AM-5:OOPM 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 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 />