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_. nvir <br /> SAN :�� OQQUIN RECEIVonmental Health Department <br /> COUNTY 3UN ) 5 2P PUBLIp RECORDS RELEASE APPLICATION <br /> I�.N'V1ROi TPN � flr'• Q� �3 <br /> .,Y.1.,. EHD LOG NUMBER. <br /> CI Vn��Ydb1 <br /> APPLICANT: Alvaro Dominguez BUSINESS/AGENCY:Partner Science and Engineering <br /> ADDRESS: 101722nd Avenue#107 CITY/STATE/ZIP:Oakland,California 94606 <br /> PHONE(1): 650-996-2876 PHONE(2): FAX OR E-MAIL: alvaro_dominguez@live.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 /> SIGNATURE OF APPLICANT Alvaro Dominguez DATE June 16,2018 <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)464-0138, mail to the <br /> address indicated below,or email to info(cDsicehd.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. <br /> Future file reviews by the same applicant may require a$152 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: sto-Geek v,nd_,L.shy; center <br /> Specific Date Range of Information Requested: From ire-!o to Pre.e it <br /> ENVIRONMENTAL FILE ADDRESS 2 ct) <br /> HEALTH DEPARTMENT ( ponly, 9 p <br /> FILES S ecific addresses address ranges will not be accepted) EHD USE ONLY <br /> QX Underground Tank(UST) street# Street Name city <br /> Cleanup Site(LOP) CONSUMERXXOther Cleanup Site(Non-LOP)�,� 1 5757 Pacific Avenue Stockton 1"v I 1 <br /> • nX Hazardous Waste `tel 1� <br /> ❑DAIRY <br /> ❑Tiered Permitted Facility 2 <br /> X❑Aboveground Tank <br /> FX UST (Monitoring/Removal) ❑PWS <br /> 0 Hazardous Materials 3 <br /> 0 Spill/Release Response <br /> Q Solid Waste Facility/Vehicle 4 ATER QUALITY <br /> Food Facility <br /> Pool/Spa ® ITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> L]Septic Pumper Truck/ ❑HouslNc <br /> s <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM I HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility a UST <br /> Tattoo/Body Piercing <br /> SOLID WASTE <br /> Waste Tire 9 <br /> Complaint <br /> Other(Please Specify): ❑AccouNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY <br /> �. C I b l��r lin !� s�'.,( •1 ! .. ` I r r- �( �. <br /> to <br /> 1-4111t: Uj ISOC611i`r'e ots UZ <br /> Q *5 n 2 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: 'Co 17U4 ! i1 EHD as-os <br /> (0 2� Id' Inch Dam CO <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209%8-3420 1 F 209 464-0138 1 www.sjcehd.com <br />