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Nm(08/201/ 10:08 AM 14159529421 .;12094640135 D 1 <br />0%0 SAN JOAQUIN COUNTY • 60EHD LOG NUMBER <br />EGENEV rev% <br />��,�+:0 ENVIRONMENTAL HEALTH DEPARTMENT (1 <br />�vsAY 0 2017 15.E 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />WAONVJ�KTAL HM- 'Al" <br />PERMIT/SEMMICES ` " PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: David Gerhardstein BUSINESS/AGENCY: Partner ESI <br />ADDRESS: 11.1 Pine St, STE 1750 CITYISTATE/ZIP: San Francisco, C?1 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 />CIiEE>( BOX-TOXpE DiTE FtI QUEST-,$130_Fi*{T:(CASt l,C1R.GHE G{�O]VLS!] ftEQIJEi i'F30GESS13 iN 38lJSiNa Oe1YS �� <br />SIGNATURE OF APPLICANT dgerhardstein@partneres -i . c,1m DATE m '7 8, zlvl <br />Electronic Information: ❑ List ❑ Map - Description: <br />—FILE ADDRESS <br />_ <br />�ENf3�USE ONLY` S <br />Street # <br />Street game _ <br />I City <br />" <br />2G500 <br />Holly Gr.i..Ve <br />Trac <br />U14j r_,n, ��i!.� (WA';'l�j"C <br />2 <br />3. <br />a <br />i <br />4. <br />C�►QA�WJ�iP <br />6. <br />d <br />7. <br />i <br />S` <br />9SITE MiiiGATiON <br />s. <br />J-Dil k a �e <br />10. <br />Specific Date Range of Information Requested: From to <br />E~NVIR.t NlVlEfY- At HgAL,-rH DepARTMENT FIC ES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOTELIHOTEL Q SOLID WASTE FACiLITYNEHICLE <br />© OTHER CLEANUP SITE (NON -LOP) ❑ ROUSING ABATEMENT ❑ FOOD FACILITY <br />Q UNDERGROUND TANK (MONITORINGIREMOVAL) © WASTE TIRE 0 DAIRY, POOLISPA <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />Q HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY ❑ PUMPER TRUCKiYARDICHEMICAL TOILETS <br />X❑ HAZARDOUS MATERIALS ❑ TATTOO/BODY PIERCING 0 LAND USE APPLICATION SITES <br />0 TIERED PERMITTED FACILITY 0 COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVMLA13LE FOR REVIEW: MONDAY -FRIDAY 8:110 AM S;OOPM FJiCLUDENG 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 20 464-0138 gr il jo theaddress Indicated ab ve. 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 fila reviews by the same applicant may require a $130 deposit prior to review. <br />"`BOXED AREA - EHD USE ONLY'** <br />I M 0^-^rA. nr—AA^A Kk♦ Ci -11{_000 C-Qw�.�1n�n Staff Name: <br />e c e i v e d Time -Ma Y, 8.-20{7-10.04AGNo. 1483 <br />