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RAE' <br /> C'EIDiV <br /> SAN .10AQUIN COUNTY EHD LOG NUMBER <br /> � E COPY <br /> NO i 9 2016 ENVIRONMENTAL HEALTH DEPAR <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEALTH Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd 615101 <br /> PERMIT/SER'!/iCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kassandra Pay BUSINESS/AGENCY: Brusca Associates,Inca <br /> ADDRESS: 1860 Sierra Gardens Drive #332 CITY/STATE/ZIP: <br /> Roseville, <br /> PHONE(1): 916-990-7461 PHONE(2): FAX OR E-MAIL: kpay@bruscaa ciat <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 DA <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 approp <br /> box(es). At least one file type MUST be selected. Fax t (209)464-0138 or mail to the address indicated above A <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 no ove. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirm ximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for r 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 FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ❑CONSUMER <br /> "OTHER CLEANUP SITE(NON-LOP) <br /> southerly of East Pescadero Avenue Tracy <br /> EE21 <br /> APNS:213-070-74&-084 t (� <br /> 'TAZARDOUS WASTE <br /> IERED PERMITTED FACILITY V ❑DAIRY <br /> TTT <br /> ABOVEGROUND TANK 1535 East Pescadero Avenue Tracy <br /> UST (MONITORING/REMOVAL) ❑PWS <br /> HAZARDOUS MATERIALS } 1400 East Pescadero Avenue <br /> Tracy <br /> 3 1 <br /> SPILL/RELEASE RESPONSE (4 <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> "11❑""FOOD FACILITY <br /> F]POOL/SPA SITE MITIGATION <br /> n DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> HOUSING ABATEMENT 7 <br /> ❑MOTEL/HOTEL <br /> CHICKEN RANCH/DOG KENNEL Rf CUPA-UST <br /> MEDICAL WASTE FACILITY6 � <br /> I Y1 <br /> TATTOO/BODY PIERCING \ <br /> WASTE TIRE SOLID WASTE <br /> 9 <br /> COMPLAINT I <br /> OTHER(PLEASE SPECIFY): _ ❑ACCOUNTING <br /> 10 <br /> -BOXED AREA-EHD USE ONLY"" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />