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SAN .J OAO U IN Environmental Health Department <br /> '1- COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> �.°9� ,�?'" Greotness grows here. <br /> EHD LOG NUMBER: 87567 <br /> •APPLICANT: SANDRA HUANG BUSINESS/AGENCY: ALAMEDA COUNTY PUBLIC HEALTH <br /> ADDRESS: 1000 BROADWAY, STE 500 CITY/STATE/ZIP: OAKLAND,CA 94607 <br /> PHONE (1): 510-267-3250 PHONE (2): 510-273-3744 FAX OR E-MAIL: ACUTECD(a)ACGOV.ORG <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 Processed via fax by Staff. Dom M DATE November 28, 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 <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 DEPARTMENT only, g accepted) EHD USE ONLYl <br /> FILES (Specific addresses address ranges will not be acce ted <br /> ❑underground Tank(UST) Street# Street Name <br /> Cleanup Site(LOP) M CONSUMER <br /> 1703E YOSEMITE AVE MANTECA I VV <br /> Other Cleanup Site(Non-LOP) <br /> ❑Hazardous Waste I Z ' ❑DAIRY <br /> Tered Permitted Facility 2 <br /> Aboveground Tank <br /> ❑PWS <br /> ❑UST (Monitoring/Removal) <br /> 3 <br /> ❑Hazardous Materials <br /> ❑Spill/Release Response E]WATER QUALITY <br /> ❑Solid Waste Facility/vehicle 4 <br /> ®Food Facility <br /> ❑Pool/Spa ❑SITE Mmcanoe <br /> ❑Dairy 5 <br /> ❑Land Use Application Sites Ej HOUSING <br /> ❑Septic Pumper Truck/ 9 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant ❑CUPA <br /> E]Housing Abatement 7 AST/HM/HW <br /> ❑Molel/Hotel <br /> ❑CUPA <br /> ❑Chicken Ranch/Dog Kennel UST <br /> 8 <br /> Medical Waste Facility <br /> ❑Tattoo/body Piercing ❑SOLID WASTE <br /> Waste Tire 9 <br /> ®Complaint <br /> Other(Please Specify): ❑Accouenec <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> jF11/28/2017—CALLED APPLICANT TO CONFIRM RECEIPT OF PRRA. DOM M <br /> ❑ Records provided by Staff-PPR Complete. staff Name: FHQ"" <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />