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RECEIVED <br /> SAN J O A Q U I N FE8 2 0 2,313 Environmental Health Department <br /> COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> • he lilllFiO 0605 <br /> I�R� EMAIL v <br /> EHD LOG NUMBER: <br /> APPLICANT: Marie Rose Javier BUSINESS/AG ENCY:Haley&Aldrich,Inc. <br /> ADDRESS: 2033 North Main Street,Suite 309 CITY/STATE/ZIP:Walnut Creek,CA 945996 <br /> PHONE(1): 925.949.1013 PHONE(2): FAX OR E-MAIL: mlavier@haleyald6ch.mm <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 Marie Rase Javier ?= ?'=-•-- - DATE 2/20118 <br /> 1. List up to ten addresses In the space below. Address ran v <br /> ges 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. <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 /> HEALTH FILES (Specific <br /> (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ❑X Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ❑GONSUMEn <br /> Q Other Cleanup Site(Non-LOP) 1 30600 Corral Hollow Road Tracy <br /> • ❑X Hazardous WasteP <br /> �ST,LL) 4 nv a' <br /> ❑x tiered Permitted Facility 2 % <br /> FXZI Aboveground Tank <br /> FX UST (Monitoring/Removal) ❑Pws <br /> ❑X Hazardous Materials 3 <br /> ❑X Spill/Release Response J <br /> ❑X Solid Waste Facility/Vehicle 4 / wAnaOwury <br /> ❑Food Facility ( VIS/ <br /> ❑Pool/Spa Uam vmI TION <br /> ❑X Dairy 5 <br /> ❑Land Use Application Sites <br /> ❑X Septic Pumper Truck/ 6 ❑Houstrvc <br /> Yard/Chemical Toilets <br /> Q Wastewater Treatment Plant CUPA <br /> Fj Housing Abatement 7 ASTIHM/HW <br /> ❑Motel/Hotel <br /> R Chicken Ranch/Dog Kennel CUPA <br /> Q Medical Waste Facility a UST <br /> n Tattoo/Body Piercing swc Warne <br /> Q Waste Tire g <br /> Q Complaint <br /> E]Other(Please Specify): ❑AcmunnHc <br /> 1a <br /> ***BOXED AREA-EHD USE ONLY*** <br /> 2-aO—ISli• 'r-s:l <br /> Nfvl Gar1 '!'f.a re ofPMA_:^hcmel J Ac.% M1 'ile ,- <br /> na­ <br /> 0 Records provided by Staff-PPR Complete. staff Name: EHD 4S-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 />