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RECEIVEDSAN JOAQUIN COUNTY EHD <br /> gqb6 LOG NUMBER�I! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �EP ZQ20161868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> aNVIRONMENTAI HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> fRWII'Af BUSINESSIAGENCY: Phase-1 Environmental Services <br /> ADDRESS: 5216 Harwood Rd CITY/STATEIZIP: San Jose,CA 95124 <br /> PHONE(1): 408-406-0833 PHONE(2): FAX OR E-MAIL: ch6s@phase-lenvironmental.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 Christopher G Salomon DATE 09/22/2016 <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next 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. <br /> Future file reviews by the same applicant may require a$139 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 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ❑j UNDERGROUND TANK(UST) Street# Street Name City /L <br /> • C LEANUP SITE(LOP) IO�F P40w%-LO ❑CONSUMER <br /> F 71 OTHER CLEANUP SITE(NON-LOP) 385 West Grant Line Rd Tracy <br /> O HAZARDOUS WASTE ❑DAIRY <br /> O TIERED PERMITTED FACILITY 2 /A/ �,^ <br /> OABOVEGROUND TANK I NL,).Vt�r <br /> O UST (MONITORING/REMOVAL) Z� ElPWS <br /> O HAZARDOUS MATERIALS S -'}J IL <br /> O SPIL!/RELEASE RESPONSE WATER QUALITY �O j� <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 <br /> FOGG FACILITY <br /> ❑ MITI <br /> POOL/SPA SITE WTION <br /> ❑DAIRY 6 <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT UPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTELIHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> F]MEDICAL WASTE FACILITY 6 <br /> ❑TATTOO/BODY PIERCING SOLID WASTE <br /> WASTE TIRE <br /> 9 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. Starr Name: <br /> EHD 48-06 <br />