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RECEIVED <br /> (�, SAN JOAQUIN Environmental Health Department <br /> • 1T.t I" —COUNTY— JAN 12- 2058 PUBLIC RECORDS RELEASE APPLICATION <br /> ; s s Greotncss grows her clb RONMEWAL 18—IV34 <br /> PEl'WITISER'&E9 EHD LOG NUMBER- {V�[ <br /> APPLICANT: Wendy Bellah BUSINESSIAGENCY: Terraphase Engineering <br /> ADDRESS: 1404 Franklin Street, Suite 600 CITY/STATE/ZIP: Oakland, <br /> PHONE(1): 510-645-1850 X83 PHONE(2): 415-314-0368 FAX OR E-MAIL: Wendy.bBllah0feffaphase COm <br /> Please allow 10 business days from date of application submittal forthe records to be available. <br /> Staff will conte an a oiyytty�nt ate and time to review the requeste reco•ds. <br /> SIGNATURE OF APPLICANT �r,Y DATE 2- J <br /> 1. List up to ten addresses!Mhd space beW. Address ranges WILL NOT be accepted. Select the type(d)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 infoansicehd.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. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From 1900 to Curren <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( P y g p <br /> FILES S ecific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> El Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) KwUoxsun,ca <br /> • ❑Other Cleanup Site(Non-LOP) ' 757 East 11th St. Tracy +- <br /> n <br /> ®Hazardous WasteW �DAIRY <br /> El tiered Permitted Facility 2 P401 N.MacArthur Drive Tracy�t J(.,A p <br /> ®Aboveground Tank <br /> I]UST (Monitoring/Removal) 0 PWS <br /> j Hazardous Materials a <br /> I]Spilt/Release Response <br /> I]Solid Waste Facility I Vehicle 4I n 1 rb ATexxqunum <br /> I] �yt/�/�Food Facility 1 I ft 1 y s <br /> ❑Pool/Spa EfSm MmwTwN <br /> ❑Dairy 6 <br /> [ Land Use Application Sites <br /> ❑Septic Pumper Truck/ ❑Housmo - <br /> 6 <br /> Yard/Chemical Tollets <br /> I]Wastewater Treatment Plant lyrKPA <br /> ❑Housing Abatement 7 AST/HM/HW <br /> I]Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel ❑CUPA <br /> 6 <br /> Medical Waste Facility UST , <br /> Tattoo/Body Piercing <br /> ❑Salo WiaTa <br /> I]Waste Tire g <br /> ❑Complaint <br /> Other(Please Specify): Accaummc <br /> 1a <br /> ***BOXED AREA-EHD USE ONLY*** <br /> • I 1 -1411-En t1e �b;rr z r o,nz etc u� t z L A YeS. t r, <br /> 0 Records provided by Staff-PPR Complete.staff Name: EHD413-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />