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� &=LIP SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> A� 0 4 209 ENVIRONMENTAL HEALTH DEPARTMENT 86085 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEAI.I#phone: (209)468-3420 Fax. (209)464-0138 Web:www.sicehd.com Email: infoCa)sicehd.com <br /> PERMITISE=RVICES PUBLIC RECORDS RELEASE APPLICATION <br /> 0 <br /> APPLICANT: Alisha C Pember BUSINESSIAGENCY: Adams Broadwell Joseph <br /> ADDRESS: 601 Gateway Blvd, Ste 1000 CITYISTATEIZIP: South San Francisco, CA 94080 <br /> PHONE(1). 650-589-1660 ext 24 PHONE(2): FAX OR E-MAIL: a ember a damsbroadwell.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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by Staff. Dom M DATE May 4, 2017 <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 list <br /> 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 above, 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 above. <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. l <br /> Future file reviews by the same applicant may require a $139 deposit prior to review. (/I) <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 /> ( <br /> HEAT-TIS DEPARTMENT EHD USE ONLY <br /> FILES Sp ecific addresses only, address ranges will not be accepted) <br /> ®UND2kGROUNO TANK(UST) Street# Street Name City <br /> I CLEANUP SITE(LOP) S Hwy 99 IR CONSUMER <br /> 1 12001 Manteca <br /> ®OTHER CLEANUP SITE(NON-LOP) (Delicato Vineyards) <br /> ®HAZARDOUS WASTE DAIRY <br /> ®TIERED PERMITTED FACILITY 2 <br /> ®ABOVEGROUND TANK <br /> ®LIST (MONITORING I REMOVAL) <br /> ®PWS <br /> 3 <br /> ®HAZARDOUS MATERIALS <br /> ®SPILLIRELEASE RESPONSE <br /> ®SOLID WASTE FACILITY I VEHICLE 4 ®WATER QGALiTY <br /> ®FOOD FACIL]TY <br /> ®POOL I.SPA 0 S[TE MITIGATION <br /> ®DN RY 5 <br /> Z LAND USE APPLICATION SITES <br /> ® ®HOUSING <br /> SEPTIC PUMPER TRUCK 1 <br /> 6 <br /> YARD/CHLM cAL TOILETS <br /> ®WASTEWATER TREATMENT PLANT ®CUPA <br /> ®HOUSING ABATEMENT 7 <br /> ®MOTELIHOTEL <br /> Z CHICKEN RANCH I DOG KENNEL M CUPA-UST <br /> 8 <br /> ®MEDICAL WASTE FACILITY <br /> ®TATTOO/1300Y PIERCING SOLID WASTE <br /> ®WASTE TIRE B <br /> ®COMPLAINT <br /> ®OTHER(PLEASE SPECIFY): ACCOUNTING <br /> Well & Septic 'D <br /> r <br /> •"BOXED AREA-EHD USE ONLY- <br /> 11 Records provided by Staff-PPR Complete. Staff Name: <br />