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"ZECE'Vnvif®i�men�-, H <br /> SAN JOAQUIN Health Department <br /> - C O U N T Y NOV 17 ZUV <br /> � IE ff8 R..t <br /> LEASE APPLICATION <br /> Greatness 9n'w` ' arc �� �� z <br /> ENVIRONMENTAL I-feAUH <br /> PEIVArE19FRA' EHD LOG NUMBER: <br /> (67 5,31 <br /> APPLICANT: Rachel Ward BUSINESS/AGENCY: AEI Consultants <br /> ADDRESS: 520 3rd Street CITY/STATE/ZIP: Oakland, CA 94607 <br /> PHONE(1): 510.907.3145 x2113 PHONE(2): FAX OR E-MAIL: rward aPirnnsiiltants rnm <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 DATE Nov 9,2017 <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)slcehd.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. <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 all to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> ( p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ® Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUMER <br /> FX Other Cleanup Site(Non-LO 11800 Harlan Road Lathrop <br /> ©Hazardous Waste DAIRY <br /> Q Tiered Permitted Facility 2 <br /> MAboveground Tank <br /> ®UST (Monitoring/Removal) ❑PWS <br /> Hazardous Materials 3 <br /> ®Spill/Release Response <br /> Solid Waste Facility/Vehicle 4 ATER QUALITY <br /> Food Facility <br /> E]Pool/SpaTE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> ©Septic Pumper Truck/ 6 OUSING <br /> Yard/Chemical Toilets <br /> ®Wastewater Treatment Plant '].CEPA <br /> ❑Housing Abatement 7 ASI/HM/HW <br /> ®Motel/Hotel <br /> Chicken Ranch/Dog Kennel J/� UPA <br /> iJ' <br /> Medical Waste Facility �, UST <br /> Tattoo/Body Piercing <br /> ®Waste Tire 8 �]SOLID WASTE <br /> ®Complaint ((/—Jf\ NA <br /> Other(Please Specify): 11ACCOUNTING <br /> 10 <br /> I I <br /> *-BOXED AREA-EHD USE ONLY... <br /> 11-(1 t _ I SLYLL(Lv\ n I,-. `IA'—Z oece 4 p n 40-VA ot kl\ 1"— <br /> L <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD4a-o6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />