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SANJOAQUINRECEII� ronmental Health Department <br /> COUNTY-- )L� ^� 5 �Q3 PUBLIC RECORDS RELEASE APPLICATION <br /> _.� ��• <br /> EH �3 <br /> D LOG NUMBER: <br /> APPLICANT: Alvarcoominguez BUSINESS/AGENCY:Partner Science and Engineering <br /> ADDRESS: 1017 22nd Avenue k 107 CITY/STATE/ZIP:Oakland,California 94606 <br /> PHONE (1): 650-996-2876 PHONE(2): FAX OR E-MAIL: alvaro_dominguez@live.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 /> SIGNATURE OF APPLICANT Alvaro Dominguez DATE Jane 16.2018 <br /> 1. List un 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 recordsl 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. ( J <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: stone Creek Village Shopping Center <br /> Specific Date Range of Information Requested: From 197o to Present <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y g p ) EHD USE ONLY <br /> FILES addresses onlyaddress ran es will not be acce ted <br /> Q Underground Tank(UST)) Street# Street Name city <br /> Cleanup Site(LOP) y/ Vy/ fS I D e E]Corvsuuee <br /> QX Other Cleanup Site(Non-LOP) 1 5757 Pacific Avenue Stockton1 V f {Irw <br /> • 0 Hazardous Waste El DAIRY <br /> F Tiered Permitted Facility 2 <br /> Q Aboveground Tank UJP NW HM U5T <br /> X❑UST (Monitoring I Removal) D PW8 <br /> a <br /> ❑X Hazardous Materials <br /> Q Spill/Release Response <br /> lXj Solid Waste Facility/vehicle q �h'I11 ATSRewtm <br /> ❑Food Facility <br /> Pool/Spa ITE MiTwnnery <br /> Dairy 5 <br /> Land Use Application Sites <br /> ❑Septic Pumper Truck/ ❑Housirvc <br /> s <br /> Yard/Chemical Toilets _ <br /> E]Wastewater Treatment Plant igCUPA <br /> Housing Abatement 7 AST/HM IHW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility a UST/ <br /> Tattoo/Body Piercing Souo WASTE <br /> Waste Tire a <br /> Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> J <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />