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SAN .JOAQUINRECE'VERvironmental Health Department <br /> --COUNTY--- DEC d 9 2017 pij PUBLIC RECORDS RELEASE APPLICATION <br /> G�ecrnttss aror;s hr 1 1 <br /> ENVIRONMENTAL HFALTH� 77� <br /> prRlA"ERVl, EHD LOG NUMBER: <br /> APPLICANT: Bailey-,BalShor BUSINESS/AGENCY:Partner Engineering and Science, Inc <br /> ADDRESS: 135 L Street CITY/STATE/ZIP: Sacramento CA 95814 <br /> E <br /> PHONE(1): 916-823-7555 PHONE(2): FAX OR -MAIL: BBalshorR-Partneresi.Com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will conta yo Ie. " <br /> arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT 'r, DATE 12-21-17 <br /> 1. List up to ten addresses in the splow. Address ranges WILL NOT be accepted. Select the types)of files from the <br /> list below by checking the appropox(es). At least one file type MUST be selected. Fax to 1209)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. (/rJlf <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 FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) <br /> FILES EHD USE ONLY <br /> _j-Underground Tank(UST) Street# Street Name city - <br /> X Cleanup Site(LOP) O CONSUMER y <br /> ®Other Cleanup Site(Non-LOP) ' 930 East Charter Way Stockton <br /> ® Hazardous Waste []DA�RY <br /> ®Tiered Permitted Facility P 17ry �P o 1 `l-.k ►�lyy�. t'1 Lyyt/t t�.� �U� ll.� <br /> ©Aboveground Tank <br /> PWS <br /> ®UST (Monitoring/Removal) <br /> 3 <br /> ®Hazardous Materials <br /> ®Spill Release Response ATM QUAL" <br /> Solid Waste Facility/Vehicle 4 Af <br /> Food Facility <br /> ❑Pool/Spa a VIITEMmwoN <br /> Dairy AVArtLA 91K <br /> / <br /> N - <br /> ❑Land Use Application Sites p Heusmo <br /> Septic Pumper Truck/ a 1�lo�t <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> ASTIHM/HW <br /> Housing Abatement 7 <br /> ❑Motel/Hotel CUPA <br /> n Chicken Ranch/Dog Kennel UST <br /> 9 <br /> Medical Waste Facility <br /> n Tattoo/Body Piercing ❑soum WASTE <br /> Waste Tire 9 <br /> Complaint <br /> AcwUMrlNc <br /> Other(Please Specify): <br /> 10 <br /> ***BOfXED AREA-EHD USE ONLY**py* <br /> of Z'A 70j, <br /> ❑ Records provided by Staff-PPR Complete- Staff Name: BHD 48 09 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />