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E I VE <br /> SAN J OA Q U I N Environmental Health Department <br /> ---C O U N T r' ' 'N 18 i PUBLIC RECORDS RELEASE APPLICATION <br /> EM.11PMbrIAL lrr.+t'1.7 H �1V <br /> M <br /> IP�E11� MSl MICE EHD LOG NUMBER:�3 ct ct <br /> APPLICANT: Jane Xiao BUSINESS/AGENCY: Partner Engineering and Science, Inc. <br /> ADDRESS: 111 Pine Street, Suite 1750 CITY/STATE/ZIP: San Francisco, CA 94111 <br /> PHONE (1): 415-934-9043 ext. 3357 PHONE (2): 628-233-7258 FAX OR E-MAIL: jxiao(a)partneresi.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 �, ,„ ?;_ ,- 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)464-0138, 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. ll <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 u�7 b" Iq-� <br /> HEALTH DEPARTMENT ( p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ® Underground Tank(UST) Street# Street Name City _^ <br /> Cleanup Site(LOP) �S r ❑CONSUMER U✓ <br /> ®Other Cleanup Site(Non-LOP) 1 5606 Pacific Avenue Stockton N D a <br /> Hazardous Waste <br /> yrvj l-A C /V�/o 0� /'} <br /> ❑DAIRY <br /> ®Tiered Permitted FacilityJ2 " <br /> ®Aboveground Tank 5756 Pacific Avenue , • Stockton Ajo 11 <br /> ®UST (Monitoring/Removal) ❑PWS <br /> ®Hazardous Materials 3 , <br /> ®Spill/Release Response L ' <br /> ®Solid Waste Facility/Vehicle 4 TER QUALITY (,D <br /> Food Facility 5 1} ( ( /1` X <br /> ❑Pool/Spa SITE MITIGATION <br /> Dairy 5 <br /> ® Land Use Application Sites <br /> Septic Pumper Truck I 6 C]HOUSING <br /> Yard/Chemical Toilets <br /> ©Wastewater Treatment Plant gcOPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel i?rCUPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing <br /> Souo WASTE <br /> ®Waste Tire 9 <br /> ®Complaint <br /> F1 Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE• `ONLY***"'r '-� .` u� a:—rwt D.( "0.11i2i <br /> q C. <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: s-os <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />