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11111!/13/2018 11:46 AM 14159529421 Rr 004640138 0 1 <br /> SAN'4"JDA QUIllOf�l�, ntal Health Department <br /> -'---C":0 LJ N T'Y--`-- MAR 13 2018 PUBLIC RECORDS RELEASE APPLICATION <br /> 946zob <br /> ixt'^k��yswp/y��y� <br /> • .. �r,'��4MALH� <br /> e9ffi tT `IS�1 M EHD LOG NUMBER: <br /> APPLICANT: David Gerhardstein BUSINESS/AGENCY: Partner EST <br /> ADDRESS: 111 Pine St, STE 1750 CITY/STATE/ZIP: San Francisco, CA 94111 <br /> PHONE(1): 415.599.1184 PHONE(2): FAX OR E-MAILIigerhardstein@part Haze si.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 reviewthe requested records. <br /> SIGNATURE OF APPLICANT David Gerhardstein DATE 3/1.3/18 <br /> 1. List Op 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)484-0138, mall to the <br /> address indicated below,or email to Info0sicehd.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 Ole not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. . j I <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-S:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Ma —Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL 1 FILE ADDRESS <br /> HEALTH DEPARTMENT accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be ac <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) <br /> . ©Other Cleanup Sit.(Non-LOP)r— <br /> Spill <br /> 4199 Gibraltar Court r5 tockten r <br /> ® <br /> Hazardous Waste T 0 Dum, <br /> © <br /> Tiered Permitted Facility h?O1 <br /> ® Gibraltar Court St ock[On <br /> Aboveground Tank <br /> ® <br /> UST (Moniloring 1 Removal) I ❑PWS <br /> x,41-aK �fetec<sc I6 � <br /> ® <br /> Hazardous Materialst <br /> ® /Release Response <br /> Mrcu Ouum <br /> Q Solid dht Faa7ry 1 Vehicle < <br /> r. (� <br /> Food Fadtity <br /> Pool I spa Sie MMGATi V <br /> F1 Dalry s <br /> Q land Use Application Sites <br /> ❑np siva <br /> Q Septic Pumper l Toilets S <br /> Yard I Chemical Toilets <br /> X Wastewater Treatment Plant L I \ /�6�, <br /> (/'/ "' ' { SI11 IT(k) P'V L- COPA <br /> Housing Abatement T ASTlNMIHW <br /> Motelmolel <br /> Chicken Ranch I Dog Kennel6 C1 ` UST <br /> Modicoi waste Facilely , <br /> TattooBody Plerclrg '—' I el SI Wssre <br /> MXWasteTim (� -Fa J re loin fc. <br /> MX Complaint <br /> ❑Other(Please Specify): I r, I �^ 1 C'5 0 Accoun-mc <br /> tl <br /> "'BOXED AREA-EHD USE ONLY" <br /> • 3-t3-! -4-,Ile --I�n�t Lo^ vrt.� Ic�zi�t u4- 'e2� -� ar,�-c �F[�, -�z t.a���rICS. <br /> 0 Records provided by Staff-PPR Complete. slan Name: eaa 4&06 <br /> Received TimerMar. 13, 1r2018`11 : 38ANPNo. 3213)52051 T 209 468-3420 1 F 209464-0133 1 www.sicehd.com <br />