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t 1�" SAN J O A Q U I N it 201b Environmental Health Department <br />---COU N TY-- PUBLICS RECORDS RELEASE APPLICATION <br />:�M.�erit (^ ,.: 0 i n L= 5 ? G : o Iv < h p r,-�i�i%I�II - <br />.. PERMIT EMAIL I SINr� �,L.� <br />yAU PIS EHD LOG NUMBER: Ly/ 7( <br />APPLICANT: Erik Brown BUSINESS/AGENCY: AEI Consultants <br />ADDRESS: 520 Shellv Drive <br />CITY/STATE/ZIP: Pleasant Hill, CA 94523 <br />PHONE (1): 925-262-8101 PHONE (2): FAX OR E-MAIL: ERIK@MNM-ENV.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 appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT Erik Brown DATE , 11 <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. l <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 to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />only, address ranges will not <br />y 9 <br />accepted) <br />be acce ted <br />EHD USE ONLY <br />RI Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />' <br />2402 <br />South California Street <br />Stockton <br />+t, ftm sP' C0 1.SP EIC ... u,", <br />Cleanup Site (LOP) <br />QOther Cleanup Site (Non -L <br />Q Hazardous Waste \ <br />❑ DAIRY <br />Q Tiered Permitted Facility\ <br />2 <br />Q Aboveground Tank <br />�� Lll� itM w 1j <br />❑ PWS <br />QX UST (Monitoring /Removal) <br />❑X Hazardous Materials <br />3 <br />Q Spill / Release Response <br />4 <br />ATER QUALITY <br />❑ Solid Waste Facility / Vehicle <br />❑ Food Facility <br />SITE MITIGATION <br />❑ Pool / Spa <br />Dairy <br />5 <br />Land Use Application Sites <br />E]HOUSING <br />Q Septic Pumper Truck Is <br />Yard / Chemical Toilets <br />QX Wastewater Treatment Plant <br />COPA <br />Housing Abatement <br />7 <br />AST I HM I HW <br />❑ Motel/Hotel <br />COPA <br />Chicken Ranch / Dog Kennel <br />Fj Medical Waste Facility <br />a <br />UST <br />Tattoo/Body Piercing <br />SOLID WASTE <br />7 Waste Tire <br />9 <br />Complaint <br />❑ AccouNTING <br />Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />�'l�"l — � 1"� I • r' re' C� c,>.- :;ice 1t "C. •v� "il��l c)'.�, i � („"�. ' "L I i <br />2(3-1 3 0 33-E-1 4,-b U)nd�9!71q ram in Hyy aas Cr51 <br />-2C�—tx d2ot <br />❑ Records provided by Staff -PPR Complete. staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />