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UO/NI/ IU:UO HI"I 01 <br /> � ■ ECE <br /> SAN �OAQUIN COUNTY EHD LOG NUMBER <br /> 'E 0 <br /> N <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1-03AY 0 , 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> �+i1rlRONN N'TAL IWAV <br /> PERMITrSEMACES PUBLIC RECORDS RELEASE APPLICATION " <br /> APPLICANT: David Gerhardstein BUSINESS/AGENCY: Partner ESI <br /> ADDRESS: !1I Fine St, STE 1.750 CITY/STATE/ZIP: San Francisco, CA 94111 <br /> PHONE(1): 415 .5 99 . 1184 PHONE (2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available.�J <br /> Staff will contact you to arrange,an appointment date and time to review the requested records. <br /> ❑':CNEG.K_BpX T.O.ES4f?EDITE:REQUEST-$t30 FEE�CASH;ESR CNECK:ONLY7-;flEQIIEBT PRo ESSEt3(N 3 B.l7SiNE B.C7A1!S jl <br /> SIGNATURE OF APPLICANT dgerhardstein@part-neresi .com DATE May n, 2017 7 <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS-� � EHD USE ONLY <br /> Street# Street Name {� City <br /> 1 207U0 Holly Dri.Je 1 Tracy � (-WA <br /> 2 tdtO5 <br /> AM <br /> 1 flu est <br /> 4. CIS► -idldfrt <br /> ®! <br /> 6 <br /> T' 177 [� <br /> 8. <br /> r+ SITE MITIGATION <br /> 9. <br /> 10. 1 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONfiAENTAEALTH:DEPARTfdAfNTFILES <br /> El UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL Q SOLID WASTE FACILITY/VEHICLE <br /> ©OTHER CLEANUP SITE(NoN-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> Q UNDERGROUND TANK(MONITORING/REMOVAL) ®WASTE TIRE ❑DAIRY,POOLISPA <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ©WASTEWATER TREATMENT PLANT <br /> M HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> Q HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑X TIERED PERMITTED FACILITY Q COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S;OOPM EXCLUDING HOLIDAYS <br /> 1. List up to ten addresses in the space above. Select the type(s)of fifes from the list above 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 END 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$130 deposit prior to review. <br /> *"BOXED AREA-EHD USE ONLY*** <br /> t U-I bl�i <br /> r-7 0^-^r i w%r^,#;A^A bar ca-4f#_nno nOrN I—#- Slaff Name: <br /> Received Time_May. 8, =2017_10: 04AMl No, 1483 <br />