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RECEIVED <br /> s., SANpJOAQUIN Environmental Health Department <br /> • _•s I' > ' —COUNTY— JAN 12. 2018 PUBLIC RECORDS RELEASE APPLICATION <br /> - ONM >F,, "37836 <br /> 't,corN Greatness grolvs herE�� T�f <br /> PERMIT/SFRAbES EHD LOG NUMBER: <br /> APPLICANT: Wendy Bellah BUSINESS/AGENCY: Terraphase Engineering <br /> ADDRESS: 1404 Franklin Street,Suite 600 CITY/STATE/ZIP: Oakland, CA 94612 <br /> PHONE(1): 510-645-1850 x83 PHONE(2): 415-314-0368 FAX OR E-MAIL: wendy.bellah(o).terraohase.com <br /> Please allow 10 business days from <br /> from date of application submittal for the records to be available. <br /> Staff will con:!:; " "ne an a o'�trp�nt ate and time to review the requeste reco•ds. <br /> SIGNATURE OF APPLICANT �/,Y DATE .�- J <br /> 1. List up to ten addresses space be]QW. Ad ress ranges WILL NOT be accepted. Select the type( )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.mall to the <br /> address indicated below,or email to inforailsicehd.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. ^p <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. j6. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From 1900 to current <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y g p <br /> FILES (Specific addresses only, address ranges will not he accepted) EHD USE ONLY <br /> ®Underground Tank(US) Street# Street Name City <br /> Cleanup Site(LOP) KW ❑CoNsuHan <br /> • ❑Other Cleanup Site(Non-LOP) ' 757 East 11th St. Tracy la P <br /> ®Hazardous Waste IAV DAwr <br /> ❑Tiered Permitted Facility Z , t <br /> 2401 N.MacArthur Drive Tracy(: <br /> ®Aboveground Tank <br /> ❑UST (Monitoring/Removal) PWS <br /> IT]Hazardous Materials a <br /> ❑Spill/Release Response <br /> ❑Solid Waste Facility/Vehicle 4 1I ri rb <br /> Food Facillty <br /> Pool/Spa QSnE Mc.A1.0 <br /> Dairy 6 <br /> Land Use Application Sites <br /> ❑Septic Pumper Truck/ ❑HWSINe <br /> 6 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant UPA <br /> Housing Abatement 7 ASTIHM/HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel ❑CUPA <br /> s <br /> Medical Waste Facility UST <br /> F1 Taltoo/Body Piercing Sou.W1.TE <br /> Waste Tire 9 <br /> Complaint <br /> ❑Other(Please Specify): ❑Accou,mw <br /> to <br /> "BOXED AREA-EHD USE ONLY'"` <br /> • I At9-ob-ffmv\ea Ago I ;rr z ct e o R o.ne ' of W u C1 C'- L n e '(eS. 00v <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 49 06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />