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RECEIVED <br /> SAN J U A Q U ! N , Environmental Health Department <br /> L OU N T Y' UN 18 2018 PUBLIC RECORDS RELEASE APPLICATION <br /> W114AMWAILI-VUH (Id) 1?7 Ct 009 <br /> PEMMR/S'EMi S • EHD LOG NUMBER: <br /> APPLICANT: Jane}Ciao BUSINESSIAGENCY: Partner Engineering and Science, Inc. <br /> ADDRESS: 111 Pine Street.Suite 1750 CITY/STATEIZiP: San Francisco, CA 94111 <br /> PHONE(1): 415-934-9043 ext. 3357 PHONE(2y: 628-233-7258 FAX OR E-MAIL: jxiaa{7partneresi.cam <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 /> SIGNATURE OF APPLICANT ,,- DATE June 14,2018 <br /> 1. List up to ten addresses in the space below. Address 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)464-4138,mail to the <br /> address indicated below,or email to info s'cehd.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(10y <br /> days after receipt of application. The files will be held for a maximum of five business stays 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. �[[p <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:DDPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List[ Map—Description: <br /> Specific Date Range of Information Requested: From _ to <br /> ENVIRONMENTAL FILE ADDRESS Ax-D 1)LOI ld <br /> HEALTH DEPARTMENT <br /> FILES [Specific addresses only,address ranges will not tae accepted) EHD USE ON l.. <br /> ®Underground Tank(UST} St[eet# Street Name City <br /> Cleanup Site(LOP) sq s �]��-1�SV1, ❑Catsuu6P <br /> ®Other Cleanup Site(Hon-LOP) , ' 5606 Pacific Avenue Stockton cow A4Lel l —5 o Vp.l... <br /> Hazardous Waste 5t-\t4'w�HAk, ^ ❑0•1r�. <br /> ®Tiered Permitted Facility 2 <br /> ®Aboveground Tank 5756 nn Pacific Avenue Stockton ctNQ v+Y 5i L,I4r <br /> ®UST (Monitoring I Removal) Qr<[J�BOJ CA kI,_u,I/ ❑PWS <br /> 3 / <br /> ®Hazardous Materials ���`�(7r,_ t,6A <br /> ,[� 1! <br /> Spill I Release Response []�n rr y i"• { (�"j� <br /> R�"'� V <br /> 0 •niEF O;.klry <br /> ®Solid Waste Facility 1 Vehicle q _ !� <br /> El Food Facility a t -1�'NW_^�� <br /> D Pool i Spa [] to 7,ks: i)-`Ry/ �t (O SITE MMGATioN <br /> Dairy 7 <br /> ®Land Use Application Sites HOUSING <br /> Septic Pumper Truck I 6 <br /> Yard I Chemical Tailets f <br /> wastewater Trealmenl Plant EfCUPA <br /> Housing Abatement 7 AST I HAA I HW <br /> MolellHotel <br /> CVPA <br /> Chicken Ranch I Dog Kennel <br /> a <br /> UST <br /> ❑Medical Waste Facility <br /> ❑TaltoolBody Piarcing SV rD WASTE <br /> ®waste Tire g <br /> ®Complaint <br /> F1 Other(Please Specify). ❑AccwNnNo <br /> m <br /> *"BOXED AREA-EHD USE ONLY"' <br /> Aftz-ti, {4 r v_l i.5.. R-it r. r 7 t '{ :�.i.1 ,.• t ,n•. 1 L I r. i+Irl r !�? <br /> �Pr Flr�� �r �nrtnf�;n ,�'L��IC: r�t� aio -. �h �ae��►,LO <br /> ❑ Records provided by Staff-PPR Complete. staff Marne; EHD4a•os <br /> 1868 E- Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />