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_RF V AE NE D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT gqb &SEP 2 2 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> RONMENT&HEEILTM PUBLIC RECORDS RELEASE APPLICATION <br /> XWER'�olomon EUSINESSIAGENCY: Phase-1 Environmental Services <br /> ADDRESS: 5216 Harwood Rd GITYISTATE/ZIP: San Jose,CA 95124 <br /> PHONE(1): 408-406-0833 PHONE(2): FAX OR E-MAIL: Chris@phase-lenvironmental.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 Christopher G Solomon DATE 09/22/2016 <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(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 $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 to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> Z UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ,�,I ❑CONSUMER <br /> �.OTHER CLEANUP SITE(NON-LOP) �"" West Grant Line Rd Tracy � l t'rvl' �f � <br /> ❑J HAZARDOUS WASTE ❑0AJR, <br /> []TIERED PERM ITTEU FACILITY <br /> [DABOVEGROUNU TANK _ <br /> UST (MONITORING I REMOVAL) ❑PWS <br /> E]HAZARDOUS MATERIALS 3 <br /> O SPILURELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 WATER QUALITY <br /> r <br /> FOOD FACILITY <br /> 7 POOL I SPA SITE MITIGATION <br /> DAIRY $ <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK I ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT UFA <br /> Ej HOUSING ABATEMENT 7 <br /> MOTEL/HOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> F1 MEDICAL WASTE FACILITY 8 <br /> TATTOO/BODY PIERCING ❑SOLm WASTE <br /> WASTE TIRE <br /> 9 <br /> ❑COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑AEAOUNTING <br /> 90 <br /> —BOXED AREA-EHD USE ONLY° <br /> ❑ Records provided by Staff-PPR Complete. staff(Jame: r 0 <br /> EHD 48-06 + <br />