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RECEIVE <br /> SAN ) OAQ U I �;� � Environmental Health Department <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness growsh iiOfYA�k[� <br /> (1'/6E;;;;MAIL Ce 1 `L <br /> • EHD LOG NUMBER: ��/// <br /> APPLICANT: Dariush Dastmalchi BUSINESS/AGENCY: TMC <br /> ADDRESS: 2415 San Ramon Valley Blvd 4-306 CITY/STATE/ZIP: San Ramon, CA 94583 <br /> PHONE(1): 925-353-3824 PHONE (2): FAX OR E-MAIL: dariushd@trangt.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 apppointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT Dariush DastmalclTi DATE 6/20/2018 <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(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 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. l <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 FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) Pp.( — q J C SUMER <br /> Other Cleanup Site(Non-LOP) ' 8830 W. Linne Road Tracy } <br /> HM KW QDc9aDX Q6--ICt'50 <br /> • Hazardous Waste a, DAIRY <br /> ❑Tiered Permitted Facility z 8872 W. Linne Road Tracy�] <br /> �i Aboveground Tank �f1 '`hl <br /> UST (Monitoring I Removal) PWS <br /> 3 � <br /> ®Hazardous Materials <br /> ®Spill I Release Response 1U <br /> WATER QUALITY <br /> Solid Waste Facility I Vehicle 4 <br /> Food Facility <br /> Pool/Spa ITE MITIGATION <br /> Dairy <br /> 5 <br /> ❑Land Use Application Sites <br /> HOUSING <br /> F-1Septic Pumper Truck/ 5 <br /> Yard/Chemical Toilets <br /> ®Wastewater Treatment Plant CUPA <br /> F]Housing Abatement 7 AST I HM I HW <br /> F1 Motel/Hotel <br /> Chicken Ranch I Dog Kennel CUPA <br /> 8 UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing SOLID WASTE <br /> F]Waste Tire e <br /> Complaint <br /> Other(Please Specify): <br /> ACCOUNTING <br /> 10 <br /> 'BOXED AREA-EHD USE ONLY' <br /> G ! ,), 'n, ,r& re(J0 v 't'\,I 4. AormA de- JN Lam, Ino (_'((t11 01 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />