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S b N O AQ lJ I N RECEIVWironmental Health Department <br /> ---C O U N T Y------ MAY 15 2018PUBL RECORDS RELEASE APP(,L�ICATION <br /> �xrr rt_W P� V V-7c <br /> ENVIRONMILAI� G11AAlL I� <br /> • p !'1� EHD LOG NUMBER. <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): 650-996-2876 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 DoniingueZ DATE r,t=/IF 201x, <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 infoCcDsicehd.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. ;Z_1 <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 AIC—D 2-S <br /> TY <br /> HEALTH DEPARTMENT (Specificonly, 9 p ) EHD USE ONLY <br /> FILES addresses address ranges will not be accepted) <br /> ❑x underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) *pea t C D'50 ❑CONSUMER <br /> Q Other Cleanup Site(Non-LO ' 1250 South VViIson Way# B-10 Stockton <br /> Fxj Hazardous Waste ❑DAIRY <br /> n Tiered Permitted Facility 2 1250 South Wilson Way Stockton <br /> Q Aboveground Tank ST <br /> ❑PWS <br /> Q UST (Monitoring I Removal) <br /> 3 <br /> ❑K Hazardous Materials ,`";P� �M NW 1AyT <br /> Q Spill/Release Response ATER QUALITY <br /> Q Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> Pool/Spa 2'9ITE MITIGATION <br /> El Dairy 5 <br /> ❑Land use Application Sites ❑HOUSING <br /> Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant ©CUPA <br /> Housing Abatement 7 AST I HM/HW <br /> Motel/Hotel <br /> �CUPA <br /> Chicken Ranch I Dog Kennel <br /> 8 UST <br /> ❑Medical Waste Facility <br /> 0 Tattoo/Body Piercing ©SOLID WASTE <br /> ❑Waste Tire 9 <br /> Complaint <br /> AccouNnNc <br /> Other(Please Specify): ❑ <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Sta f-PPR Complete. staff Name: JAz" 2 HD 413-13s <br /> coow3iw 000011921 r5 1n 09 6ips. mm /I- CD <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.,sjcehd.com <br />