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:20 AM <br /> /04/2017EHE FIVEp 14159529421 �12094540138 0 1 <br /> � � �� SAN RECEIVED COUNTY EHD LOG NUMBER <br /> rENVIRONMENTAL HEALTH DEPARTMENT <br /> rDEC 6 4 2017 \-11 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: {209} 468-3420 Fax; (209) 464-0138 Web: www.sjgov.org/ehd <br /> *&.11RONMENTALN�l..r�iPUBLIC RE '�/ERMIT/SEi� n CORDS RELEASE APPLICATION <br /> APPLICANT:_David Gezhardstein -- --- - BUSINESS/AGENCY: Partner ES I <br /> ADDRESS: Ill Pine St, STE 1750 CITY/STATE/ZIP: San Francisco, CA 94111. <br /> PHONE (1): . 415 . 599 .1184 PHONE (2): _ _FAX OR E-MAIL: <br /> Please allow O 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 /> El CHECk BOX TO XPEDI CE INQUEST•:$#:3t}FEE(CASH OR CHECKONL1")-;1REQUEST PROCESSED IN 3 W81NESS DAYS <br /> SIGNATURE OF APPLICANT dgerhardstein@partneresi . corm_ DATE December4, 201 , 12/ <br /> Electronic Information: R List❑ Map--Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 1' 2374 Navy Drive Stockton <br /> �f <br /> 2. <br /> 3. H M it <br /> 4. <br /> 5. <br /> 7. <br /> L9'SITE MITIGATION <br /> 9. <br /> 0. <br /> Specific Date Range of information Requested From _ _ to <br /> ENVIRONMENTAL.HEALTH_ t]EFpWRTfulC1�FFILES-- <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> Q UNDERGROUND TANK(MONITORiNGIREMOVAL) ®WASTE TIRE ❑DAIRY,POOL/SPA <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCNI DOG KENNEL ®WASTEWATER TREATMENT PLANT <br /> kv" HAZARDOUSWASTE ❑MEDICAL WASTE FACILITY ❑PLIMPERTRUCKNARDICHEMICALTOILETS <br /> x❑HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING El <br /> LAND USE APPLICATION SITES <br /> fl TIERED PERMITTED FACILITY ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> I. List u9>to ten addresse§in the space above. Select the type(s)of files from the list above by checking the appropriate J <br /> box(es). At least one file type MUST be selected. Fax to(209)4k4-0138 or mail to the addres$ 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 it any EHD files exist. An appointment for review will be confirmed approximately ten (1 D) <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 salve 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„-,EH[3 USE ONLY•*• <br /> 6 t�� --- <br /> .Q <br /> I-1 fi-ODD nQ►�r.ln�e� Staff Name: ” ,7 <br /> Received Ti4. =2017=] 1 : 140=k 2659 <br />