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SAN ,JOAQ U I N RECE'V%ironmental Health Department <br /> C O U N T Y -- MAY � 5 20�� PUBL� RECORDS RELEASE APPLICATION <br /> ENVIRONM I� E IL i�(Q <br /> pFRAAEHD LOG NUMBER. �cv <br /> • IT nnrn <br /> APPLICANT: Alvaro Dominguez BUSINESS/AGENCY:Partner Engineering and Science <br /> ADDRESS: 1017 22nd Avenue Suite 107 CITY/STATE/ZIP:Oakland California 94606 <br /> PHONE(1): 650-996-2x76 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 Ia'/ 15 2016, <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 infoOsicehd.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. .ZLj <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 FILE ADDRESS �'�'� <br /> HEALTH DEPARTMENT p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> ❑X Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) *De.,>t t'D�S�1 ❑CONSUMER <br /> Q Other Cleanup Site(Nan-LO ' 1250 South Wilson Way# B-10 Stockton <br /> • ❑X Hazardous Waste ❑DAIRY <br /> ❑Tiered Permitted Facilityz 1250 South Wilson Way Stockton 67ra <br /> ❑X Aboveground Tank 51 `y <br /> RX UST (Monitoring/Removal) ❑PWS <br /> 3 <br /> QHazardous Materials ACA- �M 4w �yT <br /> Q Spill/Release Response �7l <br /> OMIATER QUALI I V <br /> ❑X Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> Pool/Spa 'SITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> ❑Houswc <br /> ❑Septic Pumper Truck/ 6 <br /> Yard I Chemical Toilets <br /> Fj Wastewater Treatment Plant CUPA <br /> ❑Housing Abatement 7 AST/HM/HW <br /> ❑Motel/Hotel <br /> IJ Chicken Ranch/Dog Kennel ®CUPA <br /> g UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing CZ SOLID WASTE <br /> Waste Tire y <br /> ❑Complaint <br /> F]Other(Please Specify): ❑AccouNnNc <br /> �o <br /> n A —BOXED AREA-EHD USE ONLY— <br /> • G ual2 4 e- ( Om-15L— <br /> ZS1W-ffer <br /> 1 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: Z I HD48-06 <br /> &-,0021hf&,C.00W 3iial, Itr R� �C0001192d' f5 in UST Fid. F ,j(W [>rn I- CD <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.ejcehd.com <br />