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RECE IVEO <br />SAN J 0 A Q U I NEnvironmental Health Department <br />COUNTY— rY,�eY1 PUBLIC RECORDS RELEASE APPLICATION <br />{{ J <br />Eli IRONMEaS�yU ��� <br />PEMMIT18 EL�'� EHD LOG NUMBER: & i <br />APPLICANT: Melanie Mariotti <br />ADDRESS: 1176 Boulevard Way <br />BUSINESS/AGENCY: Paladin Law Group, LLP <br />CITY/STATE/ZIP: Walnut Creek, CA 94595 <br />PHONE (1): 925-947-5700 PHONE (2): FAX OR E-MAIL: mmariotti@paladinlaw.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 />SIGNATURE OF APPLICANT Melanie A. Mariotti DATE <br />s 5a <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 <br />list 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 below, or email to info(a)sicehd.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 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 $152 deposit prior to review.ZL <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) l <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From ,iso to F.rE,_Erl <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />FILES <br />(Specific addresses <br />(p <br />onlyaddress ran es will not <br />y 9 <br />be acce ted <br />p ) <br />EHD USE ONLY <br />❑X Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />416 <br />W. Yosemite Ave. <br />Manteca <br />p CONSUMER <br />�TI✓��� <br />Cleanup Site (LOP) <br />Q Other Cleanup Site (Non -LOP <br />Q Hazardous Waste <br />yN ❑ DaRr <br />ElTiered Permitted Facility 4 <br />2 <br />T <br />420 <br />W. Yosemite Ave. <br />Manteca <br />Iv�i L� ` y� ' <br />�6ej <br />QX Aboveground Tank <br />I t I 1 t rxv <br />❑ Pws <br />❑X UST (Monitoring / Removal) <br />Q Hazardous Materials <br />s <br />Q Spill I Release Response <br />4 <br />ATER QUALITY <br />Solid Waste Facility /Vehicle <br />Food Facility <br />ITE MITIGATION <br />Pool / Spa <br />Dairy <br />5 <br />Land Use Application Sites <br />a <br />HOUSING <br />Septic Pumper Truck / <br />Yard / Chemical Toilets <br />❑ Wastewater Treatment Plant <br />CUPA <br />Housing Abatement <br />7 <br />AST / HM I HW <br />F] Motel/Hotel <br />CUPA <br />❑ Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />S <br />UST <br />Tattoo/Body Piercing <br />SOLID WASTE <br />Waste Tire <br />9 <br />Q Complaint <br />F] Other (Please Specify): <br />❑ ACCOUNTING <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />Ilk I <br />❑ Records provided by Staff -PPR Complete. staff Name: (; EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.coi-n <br />/ce <br />