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-om: Erik Brown Fax: (888) 828-2635 To: 12094640138@rcfax.cc Fax: +12094640138 a 2 of 2 04/0912015 10:36 AM <br />'�[1•-.pD SAN JOAQUIN COUNTY EHD LOG NUMBER <br />IPPR 0 9 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />FNVIRONMENiAL HEAt.I't-I <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br />� <br />PERMfrfSERVIGGS PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Erik Brown <br />ADDRESS: 520 Shelly Drive <br />BUSINESS/AGENCY: Partner ESI <br />CITY/STATE/ZIP: . Pleasant Hill, CA 94523 <br />PHONE (1): (925) 262-8101 PHONE (2): (925) 305-5337 FACSIMILE: (888) 828-2635 <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 - SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE April 9, 2015 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />END USE ONLY <br />0 Unit 1 <br />I'tf iv 1 1 <br />❑Unit 2 <br />1. <br />Street # <br />2895 <br />Street Name _ <br />i North Naglee Road <br />City <br />j Trac <br />2. <br />3. <br />-- <br />� <br />❑ Unit 3 <br />4' <br />[Ti 4 <br />6. <br />7. <br />7 <br />—\.- `1 ❑ Unit s <br />8• <br />9. <br />❑ Unit 6 <br />10. <br />I <br />Specific Date Range of Information Requested: From All to All <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <br />® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />[� UNDERGROUND TANK (MONrrORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />® HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEMK:AL TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (ExCLUDING HOLIDAYS) <br />1. List up to ten addresses In the space above. Select the type(s) of files from the list -above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />1 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 $130 deposit prior to review. "'BOXED AREA - EHD USE ONLY` <br />1 ❑ Records provided by Staff -PPR Complete. Staff Name: <br />_Received Time—Apr. 9._2015_10:36AM_No.8488 <br />//C7 <br />