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RECEIVED <br />., SAN JUA�U 11UL 17 2016 Envir®nmel._-Al Health Department <br />—COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br />FJ(fli7AQNNfEPf±AI= F�Q t i <br />PEMM%RV FMAII <br />EHD LOG NUMBER: <br />APPLICANT: Addan M. Angel BUSINESS/AGENCY: AEI Consultants <br />ADDRESS <br />135 Riviera Drive #518 <br />CITY/STATE2IP: Los Gatos) CAI 95032 <br />PHONE (1): 831-331-3547 PHONE (2): FAX OR E-MAIL: <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 Adrian Angel DATE mule <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 infoRsicehd.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. 2-S <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑X List ❑ Map — Description: <br />Specific Date Range of Information Requested: From Any to Any <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />S ecific addresses <br />(p <br />only, address ran es will not <br />y 9 <br />be acce ted <br />p ) <br />EHD USE ONLY <br />Q Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />1 <br />16855 <br />South Harlan Road <br />Lathrop <br />art <br />y <br />Q Other Cleanup Site (Nan -LOP) <br />Q Hazardous WasteI <br />13 Daav <br />❑X Tiered Permitted Facility <br />2 <br />-711-1 <br />0 Aboveground Tank <br />I <br />Lj G PWS <br />❑X UST (Monitoring / Removal) <br />Q Hazardous Materials <br />3 <br />(� <br />❑X Spill/ Release Response <br />4 <br />[d' ATER Quem <br />❑X Solid Waste Facility /Vehicle <br />❑ Food Facility <br />p`Srre Mn1GRn0N <br />Q Pool / Spa <br />FX Dairy <br />5 <br />Q Land Use Application Sites <br />Houses <br />Q Septic Pumper Truck / <br />6 <br />p <br />Yard I Chemical Toilets <br />nX Wastewater Treatment Plant <br />pCUPA <br />❑X Housing Abatement <br />7 <br />ASTIHM/HW <br />Q Motel/Hotel <br />I <br />p CUPA <br />❑ Chicken Ranch I Dog Kennel <br />❑X Medical Waste Facility <br />a <br />UST <br />❑ Tattoo/Body Piercing <br />®fie WAsre <br />❑ Waste Tire <br />a <br />E] Complaint <br />❑ Accou"M <br />Other (Please Specify): <br />10 <br />•"BOXED AREA - EHD USE ONLY`" <br />—7 s � or,� RD: ✓ <br />1, - <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 4a-06 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />