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SAN_.;J <br /> .. OA Q U ! N RECEIVnvironmental Health Department <br /> COUNTY0� <br /> �r,•c�tncss Grass hF <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> C Y q <br /> • <br /> Lwno T 'IN EHD LOG NUMBER. <br /> APPLICANT: Alvaro Dominguez BUSINESS/AGENCY:Partner Science and Engineering <br /> ADDRESS: 1017 22nd 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,zoic <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(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. <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: s:one cF­ cerife, <br /> Specific Date Range of Information Requested: From tg o to P e5erlt <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> pX Underground Tank(UST) Street# Street Name city t) <br /> Cleanup Site(LOP) ( / co/sr-t CONSUMER <br /> XjOther Cleanup Site(Non-LOP)�� 1 5757 Pacific Avenue Stockton ""v l� <br /> • XQ Hazardous waste 25 <br /> DAIRY <br /> Tiered Permitted Facility 2 <br /> Q Aboveground Tank in i{wlk I tnIAt,l <br /> FX UST (Monitoring/Removal) PWS <br /> Q Hazardous Materials 3 <br /> Q Spill/Release Response <br /> QX Solid Waste Facility 1 Vehicle 4 N`WATER QUALITY <br /> Food Facility <br /> Pool/Spa ® ITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> Septic Pumper Truck/ 6 ❑HOUSING <br /> Yard/Chemical Toilets <br /> Fj Wastewater Treatment Plant CUPA <br /> Housing Abatement T AST/HM/HW <br /> E]Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel Q CUPA <br /> Medical Waste Facility $ UST <br /> E]Tattoo/Body Piercing <br /> Waste Tire g SOLID WASTE <br /> E]Complaint <br /> E]Other(Please Specify): <br /> 10 ACCOUNTING <br /> ***BOXED AREA-EHD USE ONLY*** <br /> 0 <br /> - -lb I I <br /> 2 ISc1C6V`re OSS trz <br /> a 'S n 2 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: C0() q ( , EHD 48-06 <br /> (012711d' Fh nGlecK Dcm n--C'-0 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209'468-34201 F 209464-0138 1 www.sjcehd.com <br />