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oNage 3or3 9/29/2016 4:08:25 PM PDT 19492422734 From: Vertex Irvine <br /> E N SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT —715 <br /> SEP J 2096 1868 East HazeRon Avenue, Stockton,CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> &VIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> �OVrfHAWjl..�vlkifi*-Nniel Grondin BUSINESS/AGENCY: Vertex <br /> ADDRESS: 17731 Mitchell North Suite 100 CITYISTATE/ZIP: Irvine, CA 92614 <br /> PHONE(1): 949-344-2134 PHONE(2): FAX OR E-MAIL: ngrondin@vertexeng.COm <br /> Pleaseallow 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 /> 0Cl4EC1C.$6X-T6"E3(AeDrfEREr kl)<S']`*39 FEE(CASCHR C-1L,0!N[.M) FQU(;STPRDCESSED IN 38US)NESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9/29/2016 <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 /> 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. <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From All Available to <br /> ENVIRONMENTAL <br /> HEALTI#biEAR7MEN FILE ADDRESS EHD USE ONLY <br /> ❑x UNDERGROUND TANK(UST) Street# Street Name city <br /> • CLEANUP SITE(LOP) ❑CfJHSUMEF <br /> ❑OTHER CLEANUP SITE(NON-LOP) ' tD West Grant Line Road Tracy <br /> ❑HALAROOUS WASTE Duav <br /> ❑TIERED PERMITTED FACILITY z f�^,, r,, �/� <br /> ❑i ABO4EORCUNO TANK 1_t WIIA co <br /> O UST (MONITOR NG/REMW/AL) 04Y6, [I PWS <br /> O HAZARDOUS MATERIALS <br /> r7 SPILLIRELEASE RESPONSE —'� <br /> SOLD WASTE FACILITY/VEHICLE WATER OUA:TY <br /> [:] 4 - MID <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA 11 STe Mmoenrnl <br /> ❑DAIRY S <br /> ❑LAND USE APPLWITWN SITES <br /> SEPTIC PUMPER TRUG / ❑HOImNO <br /> 6 <br /> VARD!CHEAlIOP1 TOILETS <br /> ❑WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTMJHOTEL <br /> ❑CHICKEN R[ H 1 DG;KENNEL &rCUI <br /> ❑MEDICA-WASTE FACUT� 8 <br /> ❑TATTCOIaCOY PIERCING <br /> ❑WASTE TIRE ❑SCUD WAs-E <br /> B <br /> ❑COMPLAINT <br /> ❑OTHER(PLFPSE SPECIFY): ❑ACDWN"iND <br /> 10 <br /> BOXEDAREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br /> Received Time Sep. 29, 2016 4: 05PM No. 0071 <br />