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10: Page 3 or 3 9/21/2016 10:25:38 AM PDT <br />D r,--- fo% P n <br />keceivea I ilne yep, z/• zuiu lu,zzmivl ivo, uv)y <br />19492422734 From: Vertex Irvine <br />DAT IE4~ SAN JOAQUIN COUNTY EHD LOG NUMBER <br />SEP 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL ' PUBLIC RECORDS RELEASE APPLICATION <br />8q679) <br />pERtut rl-/�f=RVI('.ES <br />APPLICANT: Nathaniel Grondin BUSINESS/AGENCY: Vertex <br />ADDRESS: 17731 Mitchell North Suite 100 <br />CITY/STATE/ZIP: Irvine, Ca 92614 <br />PHONE (1): 949-344-2134 PHONE (2):_ FAX OR E-MAIL: ngrondin@vertexeng.com <br />Pleaseallow 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 />CHECK.BQX70EXPED1fEREQIJ;ESI $);39FEiE?(CASH{1_FZCHEGKONLY) REQUESTPRO;CESSEDfN3BUSIiIESSDAYS <br />SIGNATURE OF APPLICANT ,1: DATE 9/27/2016 <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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 EHD 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From All available to <br />ENVIRONMENTAL <br />HEALTWREPARWENT <br />FILE.$, <br />FILE ADDRESS <br />EHD USE ONLY <br />F_,� UNDERGROUND TANK. (UST) <br />Street # <br />Street Name <br />C ity <br />`3L, <br />.9-0G <br />Huey D;;vE <br />Tracy <br />❑ Co NIS UM_R <br />,n/ ^ <br />CLEANUP SITE (LOP) <br />a OTHER CLEANUP SITE (NON -LOP) <br />F_q HAZARDOUS WASTE <br />- <br />El DAIRY <br />F-1 TIERED PERMITTED FACILITY <br />ABO'vEGROUND TANK <br />PWS <br />UST (MONITORING, RLIAOI�•"AL) <br />fR HAZARDOUS MATERIALS <br />5 <br />F_x] SPILURELEASE RESPONSE <br />7 SOLID WASTE FACILITY ! VEHICLE <br />FOOD FACILITY <br />4 <br />VVP.TcP QUALITY <br />--_ <br />See rdm.>nnoN <br />POOL; SPA <br />F-1 DAIRY <br />5 <br />LAND USE APPLICATION SITES <br />6 <br />❑ HO;t:!n•S <br />0 SEPTIC PUMPER TRUCK 1 <br />YARD! CHEMICAL TOILETS <br />❑ WASTEWATER TREATMENT PLANT <br />CUPA <br />f-] HOUSING ABATEMENT <br />T <br />❑ MOTELiHOTEL <br />CUPA - UST <br />CHICKEN RANCH / DDG KENNEL <br />❑ MC:oicAL WASTE FACILITY <br />8 <br />TATTOO/BODY PIERCING <br />F-1WASTETIRE <br />COMPLAINT <br />9 <br />� SOLID VIASTE <br />El OTHER(PLElSE SPECIFY): <br />� AccounrNG <br />10 <br />—BOXEDAREA - EHD USE ONLY— <br />10/5 <br />