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RA�,Qlf-,IVED <br />SAN .1OAQUIN COUNTY EHD LOG NUMBER <br />NOV , 9 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 015101 ENVIRONMENTAL HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PERMIT/BERMES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Kassandra Pay BUSINESS/AGENCY: Brusca Associates, Inca <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 t (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 1900 to 2016 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />LES <br />FILE ADDRESS <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />Site hasmaddiess but IS located southerly of East Pescadero Avenue <br />APNS:213-070-74 & -084 <br />Tracy <br />CONSUMER <br />CLEANUP SITE (LOP) <br />i�l/OTHER CLEANUP SITE (NON -LO e) <br />Y AZARDOUS WASTE <br />TTTT----"'' <br />� DAIRY <br />IERED PERMITTED FACILITY <br />ABOVEGROUND TANK `` <br />�Nt <br />UST (MONITORING / REMOVAL <br />1535 <br />East Pescadero Avenue <br />Trac y <br />'N�r-YA1 Rn / I�5't' C <br />1"" 6 / � M <br />I _ <br />I ,(11�vn 1`"LbI f ❑ PWS <br />HAZARDOUS MATERIALS <br />SPILURELEASE RESPONSE <br />SOLID WASTE FACILITY / VEHICLE <br />FOOD FACILITY <br />1400 <br />East Pescadero Avenue <br />Tracy <br />V ll • f/ v �.1 <br />` <br />\ <br />' 1✓Ia� WATER QUALITY <br />l <br />POOL / SPA <br />SITE MITIGATION <br />DAIRY <br />5 <br />LAND USE APPLICATION SITES <br />6 <br />r ❑HOUSING <br />� <br />1 VVV 1'144tViVCXC--- 1 <br />SEPTIC PUMPER TRUCK/ <br />YARD / CHEMICAL TOILETS <br />TTTWASTEWATER TREATMENT PLANT <br />❑ HOUSING ABATEMENT <br />7 <br />CUPA <br />MOTEUHOTEL <br />CHICKEN RANCH / DOG KENNEL <br />CUPA - UST <br />MEDICAL WASTE FACILITY <br />S <br />TATTOO/BODY PIERCING <br />9 <br />SOLID WASTE <br />WASTE TIRE <br />COMPLAINT <br />OTHER(PLEASE SPECIFY): <br />10 <br />ACCOUNTING <br />***BOXED AREA - EHD USE ONLY*** <br />❑ Records provided by Staff -PPR Complete. Staff Name: DILL- <br />tHU 4U -OB / " / <br />