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eVr.�� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAY 0 4 20V ENVIRONMENTAL HEALTH DEPARTMENT 86085 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEAT.*phone: (209)468-3420 Fax: (209)464-0138 Web:www.s*cehd.com Email: infoAsicehd com <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> PPLICANT: Alisha C Pember BUSINESS/AGENCY: Adams Broadwell Joseph <br /> ADDRESS: _601 Gateway Blvd Ste 1000 CITY/STATE/ZIP: South San Francisco, CA 94080 <br /> PHONE(1): 650-589-1660 ext 24 PHONE (2): FAX OR E-MAIL: apember¢aUamsbroaawell G <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by Staff. Dom M DATE May 4 2017 <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 list <br /> 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 above or email to info(Wsiceholcom 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 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. /I> <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 to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name <br /> Qity <br /> CLEANUP SITE(LOP) <br /> ®OTHER CLEANUP SITE(NDN-L 12001 (Delicato Hwy <br /> neyards)99 Manteca 'L-,,,, ,� ®CONSUMER <br /> ®HAZARDOUS WASTE <br /> ®®TIERED PERMITTED FAQLrrY 2 DAIRY <br /> ®ABOVEGROUND TANK <br /> ®UST (MONITORING/REMOVAL) ®PWS <br /> ®HAZARDOUS MATERIALS 3 <br /> ®SPILURELEAEE RESPONSE <br /> ®SOLID WASTE FACILITY/VEHICLE 4 ®WATER QUALITY <br /> ®FOOD FACILITY <br /> ® <br /> POOL/SPA ID SITE MInGAnox <br /> ®DAIRY 8 <br /> ®LAND USE APPLICATION SITES <br /> ®SEPTIC PUMPER TRUCK/ B ®HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ®WASTEWATERTREATMENT PLANT ®CUPA <br /> ®HOUSING ABATEMENT 7 <br /> ®MOTELIHOTEL <br /> ®CHICKEN RANCH/DOG KENNEL ®CUPA-UST <br /> S <br /> ®MEDICAL WASTE FACILITY <br /> Z TATTOO/BODY PIERCING <br /> ®WASTE TIRE S ®SOLID WASTE <br /> ®COMPWINT <br /> ®OTHER(PLEASE SPECIFY): <br /> 4FNell & Septic D ❑ACCOUNTNG <br /> j^ —BOXED AREA-EHD USE ONLY— <br /> GODO r <br /> l <br /> 0 t4 <br /> 0 Records provided by Staff-PPR Complete. staff Name: G <br />