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SAN JOAQUIN COUNTY EHD LOG NUMBER <br />NOV � 9 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRf)NMENTAL HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 015101 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Kassandra Pay BUSINESS/AGENCY: Brusca Associates, Inc. <br />ADDRESS: _1860 Sierra Gardens Drive #332 CITY/STATE/ZIP: Roseville, CA 95661 <br />PHONE (1): 916-990-7461 PHONE (2): FAX OR E-MAIL: kpay@bruscaassociates.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 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 DATE 11/28/2016 <br />1. List up to ten addresses in the space below. Select the e(s) of files from the list below by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax ttYlInCII 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: I <br />Specific Date Range of Information Requested: From 1900 to 2016 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESSFILES <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />Site has no addlt;ss but is located southerly of East Pescadero Aven <br />APNS:213-070-74 & -084 <br />e Tracy <br />CONSUMER <br />CLEANUP SITE (LOP) <br />`OTHER CLEANUP SITE (NON -LO e) <br />AZARDOUS WASTE <br />FFY <br />❑DAIRY <br />TIERED PERMITTED FACILITY <br />A14ZBOVEGROUND TANK �y C�- <br />UST (MONITORING / REMOVALtl(11�I'��%t <br />1535 <br />East Pescadero Avenue <br />Tracy��/ <br />A �—T 7^.- 7 <br />I I`��I , / El PWS <br />HAZARDOUS MATERIALS ` <br />SPILURELEASE RESPONSE <br />1400 <br />East Pescadero Avenue <br />Tracy1 <br />t 1 �Y ((// `i <br />will <br />1 1.WATER QUALITY <br />I- ` <br />SOLID WASTE FACILITY / VEHICLE <br />FOOD FACILITY <br />POOL /SPA <br />SITE MITIGATION <br />DAIRY <br />5 <br />LAND USE APPLICATION SITES <br />6 <br />y � , � I .1�� /l - <br />' v „ <br />SEPTIC PUMPER TRUCK /[:]HOUSING <br />YARD /CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />O----''" <br />TTTTYY❑HOUSING ABATEMENT <br />T <br />CUPA <br />MOTEL/HOTEL <br />CHICKEN RANCH / DOG KENNEL <br />$ <br />CUPA - UST <br />MEDICAL WASTE FACILITY <br />S <br />TATTOO/BODY PIERCING <br />SOLID WASTE <br />WASTE TIRE <br />COMPLAINT <br />Lj OTHER(PLEASE SPECIFY): <br />❑ ACCOUNTING <br />10 <br />"`BOXED AREA - EHD USE ONLY"` <br />❑ Records provided by Staff -PPR Complete. Staff Name: JA Z L- <br />END 48-06 <br />i2,h <br />