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5 A N 10 A Q CEIVED� Environmental <br />—COUNTY ?R 1 8 2018 uy1 PUBLIC RECO <br />.,EWRONMENTAL <br />ADDRESS: 2288 BUENA VISTA AVENUE <br />Health Department <br />RDS RELEASE APPLICATION <br />-- ... --- OG537 <br />CITY/STATE/ZIP: LIVERMORE CA 94550 <br />PHONE (1): 9254475200 PHONE (2): FAX OR E-MAIL: CAT416CIT@GMAIL.COM <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to ar n and time to review the requested records. <br />SIGNATURE OF APPLICANT DATE 4A3A8 <br />1. List up to ten addresses in th ace below dress 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(cDsicehd.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. 1, <br />Future file reviews by the same applicant may require a $152 deposit prior to review. -1 /z'7 <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 PRESENT <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />�, <br />`� Specific addresses <br />only, address ranges will not <br />be accepted) <br />H D USE ONLY <br />❑X Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />+ <br />25485 <br />N <br />ST RT 4 HY <br />T <br />FARMINGTON <br />CONSUME <br />Cleanup Site (LOP) <br />X Other Cleanup Site (Non -LOP) <br />Hazardous Waste <br />kwml`vANSi F00 <br />( DAiN <br />Q Tiered Permitted Facility <br />= <br />4469 <br />E ESCALON BELLOTA RD <br />FARMINGTON <br />S <br />� 5T- L <br />[] Aboveground Tank <br />❑x UST Removal) <br />a <br />17000 <br />ST RT 120 HY <br />R`IPON <br />i <br />Steri <br />Q Hazardous Materials <br />Hazardous <br />NM HW U01 Sr' <br />) <br />Q Spill / Release Response <br />0 Solid Waste Facility / Vehicle <br />4 <br />16636 <br />E ST RT 120 HY <br />Lyt <br />R I P O N <br />Aran Uunv <br />xj Food Facility <br />XI Pool / Spa <br />RIPON <br />6 <br />16996 <br />�E ST RT 120 <br />\ <br />Iv Sire MMGAneN <br />1- <br />Q Dairy <br />X❑ Land Use Application Sites <br />nx Septic Pumper Tuck/ <br />6 <br />21801 <br />EST RD 120 HY <br />3"tl y 1 (� <br />ESCALON <br />r,1 _ ,. t 1 _ _ ousiNc <br />V(�' \(/WL <br />�v��{y—+ <br />Yard / Chemical Toilets <br />Ham U 5?s+4 <br />�htl(,J�KO� 13y <br />( - — v� %: <br />T <br />7950 <br />IS VAN ALLEN RD <br />/�ff�1j l�r <br />ESCALON <br />CUPA <br />AST I HM IHW <br />Q Wastewater Treatment Plant <br />nX Housing Abatement <br />X❑ Motel/Hotel <br />' <br />CUPA <br />❑X Chicken Ranch/Dog Kennel <br />g <br />1851 <br />VALPICO ROAD <br />TRACY <br />UST <br />Q Medical Waste Facility <br />❑X Tattoo/Body Piercing <br />.� <br />r, Souo WASTE <br />❑X Waste Tire <br />9 <br />7357S <br />MURPHY RD <br />RIPON <br />Q Complaint <br />+a <br />17428 <br />S NORTH RIPON RD <br />RIPON <br />❑ AccouNMNa <br />�. Other (Please Specify): <br />k M +e <br />SP �� <br />***BOXED AREA-EHD USE ONLY*** <br />II ❑ Records provided by Staff -PPR Complete. Staff Name: EHD 46-06 it <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wvvw.sjcehd.com <br />