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REGEIVEU <br /> DATE RECEIVED anaEHD LOG NUMBER <br /> ,�L'�I 6 9 2017 C'4Ae' 3x-^ SAN .laAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ONIVRONWNTAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> P'EIIL�i,9tTf5EFtftll <br /> F S Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Nathaniel Grondin BUSINESS/AGENCY: VERTEX <br /> ADDRESS: 16150 Scientific CITYISTATEIZIP: Irvine Ca 92618 <br /> PHONE(1): 949-344-2134 PHONE(2): FAX OR E-MAIL: ngrondin@veltexeng.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 /> ❑ CHECK BOX TO'EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT NSG DATE 619/17 <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(249)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$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 all to all <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> RX UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ❑CONSUMER <br /> 0 OTHER CLEANUP SITE(NON-LO � 2283 West March Lane Stockton <br /> C 6k r� /Co <br /> R HAZARDOUS WASTE DAJRY _ <br /> U TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> :D UST (MONITORING/REMOVAL) r []PWS <br /> ❑% HAZARDOUS MATERIALS 3 , <br /> SPILL/REI-EASE RESPONSE <br /> F-1SOLIDWASTE FACILITY I VEHICLE. I 4 WATER Y <br /> FOOD FACILITY <br /> ❑POOL I SPA ITS MITIGATION <br /> DAIRY 5 <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK []HOUSING <br /> 8 <br /> YARD I CHEMICAL TOILETS <br /> M WASTEWATER TREATMENT PLANTR_y6URA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHOTEL <br /> CHICKEN RANCH I DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY S <br /> ❑TATTOOIBODY PIERCING - <br /> WASTE TIRE E]SOLID WASTE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY" <br /> C' LI O 0�ck y 'I -- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-08 7" <br />