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RECEIVED <br /> SANdOAQUIN Environmental Health Department <br /> —COUNTY— d 201 PUBLIC RECORDS RELEASE APPLICATION <br /> • 1;_rc,;, Crcr,rnrs; RrowS Ilr : <br /> E+hft/It3EQ1414tr Rl,"i . . AIL O <br /> m 1 <br /> EHD LOG NUMBER: <br /> APPLICANT: Reena Paieja(Brokepl Gurmeet Dabb(Buyer) BUSINESSIAGENCY:Quicki Kleen Car Wash <br /> ADDRESS: 707 E Yosemeti Ave CITY/STATE/ZIP:Manteca <br /> PHONE(1): (415)666-3440 PHONE(2):(510)846-2194 FAX OR E-MAIL: rpaleja@gmaa.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 vi DATE 05;3012018 <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 infoOsicehd.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: xp List[x Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y 9 P ) EHD USE ONLY <br /> FILES addresses only,address ran es will not be acce ted <br /> ❑X Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) �G:'Lnsumsrt <br /> RX Other Cleanup Site(Non-LOP) 707 E Yosemite Ave Manteca <br /> RX Hazardous Waste p oniRr <br /> R Tiered Permitted Facility 2 <br /> RX Aboveground Tank H NW.HyT 5m, W <br /> X�UST (Monitoring/Removal) ❑PWS <br /> O Hazardous Materials J <br /> nX Spill Release Response <br /> 1 ,I11 �� OTER QuFUTv <br /> Solid Waste Facility/Vehicle 4 �r "1 I <br /> nX Food Facility <br /> Pool/Spa SnE MITIGATION <br /> Dairy s <br /> ❑Land Use Application Sites <br /> ❑HDusiNa <br /> Septic Pumper Truck/ <br /> 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant (CUPA <br /> Housing Abatement 7 ASTIHM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel CUPA <br /> 0 UST <br /> ❑Medical Waste Facility <br /> ❑TaftoolBody Piercing SOLID W65TE <br /> M Waste Tire a <br /> F]Complaint <br /> Other(Please Specify): ❑Acton". <br /> 10 <br /> "*BOXED AREA-EHD USE ONLY*' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: e1113 IR nA <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />