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ECEIVED <br /> SQA „�QQQQR Environmental Health Department <br /> —COUNTY— FEB Z 3 2098 _ PUBLIC RECORDS RELEASE APPLICATION <br /> • <br /> Grp -5s gtvgo-V <br /> � - bhNVIRONML <br /> 8160116 <br /> PERIIA SER1M€S EHD LOG NUMBER: <br /> APPLICANT: Natalie Vaughan BUSINESSIAGENCY: AEI Consultants <br /> ADDRESS: 3880 S Bascom Ave, Suite 109 CITY/STATE/ZIP: San Jose, CA 95124 <br /> PHONE(1): 408-559-7600 PHONE (2): FAX OR E-MAIL: ...jphan QAaeiconc Itantc nnm <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arran n appo ntment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT Natal�/ar� iah DATE February 23,2018 <br /> 1. List up to ten addresses in the space below. Add ss ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list 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 below,or email to info(a)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 below. <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. %r <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. / 1° <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 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY <br /> FILES addresses onlyaddress ran es will not be acre ted <br /> ®Underground Tank(UST) Street# Street Name City 6 <br /> Cleanup Site(LOP) ❑CONYaMER rt/�1 yNf�� <br /> X Other Cleanup Site(Non-LOP) 1789 W Charter Way Stockton <br /> • Hazardous Waste (LUST case #9 553) LOP,,Kk\taW 11 DAIRY <br /> Q Tiered Permitted Facility 2 <br /> Aboveground Tank v <br /> ®UST (Monitoring I Removal) 1 D PWS <br /> Hazardous Materials 3 Irvt/ <br /> ®Spill/Release Response T nTEn Qunun, <br /> Solid Waste Facility I Vehicle 4 ) I <br /> ❑Food Facility <br /> ❑Pool/Spa `1 ^,Brre'noArm <br /> ❑Dairy 5 1 (/• �/' , "� � <br /> d` Land Use Application Sites <br /> ®Septic Pumper Truck I s ausirvc <br /> 6 ttoj <br /> Yard/Chemical Toilets <br /> ®Wastewater Treatment Plant COPA <br /> Housing Abatement T AST/HMIHW <br /> ® Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> r]Medical Wase Facility 8 UST <br /> ❑Tattoo/Body Piercing Sou.WnsiE <br /> ®Waste Tire a <br /> ®Complaint <br /> Q Other(Please Specify): ❑A003k MING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> lag* C2 of R 1S'r• G rye / In_L. 4ae a+"'1 _5z- <br /> 1 <br /> z— <br /> Mri �' (!J0ii <br /> ❑ Records provided by Staff-PPR Complete. staff Name: Isxoae-0s <br /> 1868 E- Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />