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`. S A N J OAQ U I N Environmental Health Department <br /> C OU NTY— PUBLIC RECORDS RELEASE APPLICATION <br /> Grnutineis yrosys here. a?1� <br /> EHD LOG NUMBER: 1 J <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(o_�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,arrangen, appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT av DATE August 15 2018 <br /> 1. List up to ten addresses in the spa a 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(cDslcehd.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. J <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) n( <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS 29 -1 C b <br /> FILES (Specific addresses only,address ranges will not be accepted) EUSE ON <br /> L <br /> ®Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) W 1�)V ❑CONSUMER <br /> 1®Other Cleanup Site(Non-LOP) 225 Northgate Drive N . nteca O <br /> Hazardous Waste ❑DAIRY <br /> ®Tiered Permitted Facility 2 255 Northgate Drive Mantecagym' <br /> ®Aboveground Tank t <br /> ®UST (Monitoring/Removal) ❑PWS <br /> ®Hazardous Materials 3 <br /> ®Spill/Release Response <br /> ®Solid Waste Facility/Vehicle 4 ❑WATER QUALITY <br /> ❑Food Facility <br /> F]Pool/Spa ❑SITE MITIGATION <br /> ❑Dairy 5 <br /> ®Land Use Application Sites <br /> Septic Pumper Truck/ ❑6 HOUSING <br /> Yard/Chemical Toilets <br /> ©Wastewater Treatment Plant X,CUPA <br /> Housing Abatement 7 AST/HM I HW <br /> MotellHotel <br /> ❑Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility S 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 /> LZ qRD CH -100 +b- 2 S35 WTth cp — P - D G31 <br /> ❑ Records provided by Staff-PPR Con4f Tete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />