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SAN J 0 A U I N RECE'VkQironmental Health Department <br /> Q p <br /> COUNTY MAY 15 2013 PURL C RECORDS RELEASE APPLICATION <br /> ENVIRONM I IL V(5_7CW <br /> D �1 S <br /> EMD LOG NUMBER. <br /> APPLICANT: ,Alvaro Dominguez BUSINESSIAGENCY:Partner Engineering and Science <br /> ADDRESS: 1017 22nd Avenue Suite 107 CITYISTAT11i Oakland California 94606 <br /> PHONE(1): 660-996-2876 PHONE(2): FAX OR E-MAIL: alvaro_deminguez@live.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 Alvaro Donrncue DATE Ma-, i in <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 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. :6ALA <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:04 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> Electronic Information: 0 List 0 Map—Description: <br /> Specific Date Range of information Requested. From to <br /> ENVIRONMENTAL FILE ADDRESS ?�+�ta�'� W' <br /> HEALTH DEPARTMENT ( p Y 9 accepted) HD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acre ted <br /> ®Underground rank(UST) Street# Street Name City 6V <br /> Cleanup Site(LOP) 0 CBNSUPAER <br /> Q other cleanup Site(Non-LOP 1 1250 South Wilson Wa0. <br /> QHazardous waste tit.67 <br /> Wilson <br /> Way <br /> f DAfRY <br /> QTiered Permitted Facility 2 1250 South V ikon yya '�5� �aa �" co <br /> y Stockton 5-,- <br /> ❑K Aboveground Tank <br /> Q UST (Monitoring 1 Removal) ❑PWS <br /> [R Hazardous Materials ry 3 <br /> Q Spill 1 Release Response <br /> ®Solid waste Facility 1 vehicle 4 iwAr�};QLALI IY <br /> [] Food Facility <br /> Pool/Spa (F] E WTIGAnoN <br /> Dairy 5 <br /> Land Use Application Sites <br /> ❑Septic Pumper Truck f fi E]HOUSING <br /> Yard f Chemical Toilets <br /> F1 wastewater Treatment Plant j57CJPA <br /> F]Housing Abatement 7 AST!HM 1 HW <br /> MotellHotel <br /> ©Chicken Ranch!Dog KennelFj CUPA <br /> a <br /> Medical waste Facility UST <br /> Tattool6ody Piercing - - <br /> SOLID WASTE <br /> Waste Tire g <br /> complaint <br /> ❑Other(Please Specify): ❑AccouNTiNc <br /> in <br /> i f " BOXED <br /> {1tf� AREA-E{i USE ONLY*** <br /> ap <br /> v"- fe, 1� <br /> _IWA1 dt#J41i 3JOW, _ <br /> r t lbs-o �r l� <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-34 D 1= g29 64-0138 w s ce d cz 5-t g. ,�, 00/0 F QS , ' <br />