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Ai ' ` EHD LOG NUMBER <br /> 1"1� SAN .IOAQUIN COUNTY <br /> �,IM U 4 2017 C�}' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 86085 <br /> ENVIRONMENTAL HEAII#phone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd corn Email: infoasicehd com <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> WPPLICANT: Alisha C Pember BUS_INESS/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: aPembereadamsbruad-1 <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 uo toten 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(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 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. JT/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 /> 41®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) - <br /> ®OTHER CLEANUP SITE(NON-LO4 t 12001 (Delicato Hwy <br /> neyards) Manteca ®' SUMER <br /> ®HAZARGOUS WASTE WA <br /> ®TIERED PERMITTED FACILITY 2 M DAIRY <br /> ®ABOVEGROUND TANK <br /> ®UST (MONITORING/REMOVAL) ®PWS <br /> ®HAZARDOUS MATERIALS <br /> ®SPILURELEASE RESPONSE <br /> ®SOLID WASTE FACILITY/VEHICLE 4 ___EWATER QUALITY <br /> ®FOOD FACILITY <br /> ®POOL/SPA ®SITE MITIGATION®DAIRY 5 / <br /> ®LANG USE APPLICATION SITES 1 {/Y{ W <br /> /C,JL �^-�I <br /> Z SEPTIC PUMPER TRUCK/ B ®HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ®WASTEWATER TREATMENT PLANT <br /> ®®HOUSING ABATEMENT 7 CUPA <br /> ®MOTEL/HOTEL <br /> ®CHICKEN RANCH/DOG KENNEL ®CUPA-UST <br /> S <br /> ® <br /> MEDICAL WASTE FACILITY <br /> ®TATTOO/BODY PIERCING <br /> ®WASTE TIRE 9 I�SOLID WASTE <br /> ®COMPLAINT <br /> ®OTHER(PLEASE SPECIFY): <br /> ,Well&Septic 'D ❑AccoexnxG <br /> '—BOXED AREA-EHD USE ONLY" <br /> l7 DOD <br /> I' J <br /> �7 2 <br /> 0 Records provided by Staff-PPR Complete. Staff Name: G <br />