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From: Erik Brown Fax (888)828-2635 o �p®S rc (209)464-0138 Page 2 of 2 1212812017 10:52 AM <br /> FN <br /> SAN,- 01L <br /> ig( , ? --._- EC 28 ZQ17y( PUBLIC RECORDS RELEASE APPLICATION <br /> t*..'+'nnSS C}r?tw:: +>nr,EWrwfilllll FEJl <br /> rr� ++�� PIFJ.IMR..ERVtCE9 <br /> EHD LOG NUMBER:' <br /> APPLICANT: &7'r- ro-v' BUSINESSIAGENCY: pe iu )+-echh _ <br /> ADDRESS: --'L.a o. CITYISTATEIZIP: f-TAACl Il CA af <br /> PHONE(1): 115- U T- f,1 Oil PHONE(2):125'" 30 5— S 3-3-� FAX OR E-MAIL: ec-, k (,p-,r„w, - Ci, Cpept <br /> I Please allow 1 D business days from date of application submittal for the records to be available. <br /> Staff will contact you to arran n po(n t date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE l 0 U <br /> 1. List up to ten addresses in the space H0r1owis7Addro§sDnes WILL NOT be accepted. Select the type(s)of files from th <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 infoCrDsicehd.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 flies 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. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Eiectranic Information: ❑ List Map—.Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL BILE ADDRESS <br /> HEALTH DEPARTMENT y s accepted) EHD USE ONLY <br /> FILES (Specific addresses only, ranges will not be ecce to <br /> �fa <br /> underground Tank(UST) [Street# 9 J Street Nama (/� city <br /> >Oater Cleanup ) <br /> p Site(Non-LOP) 1 tl U `Cy'nl t.a+°^""�, '�� �1•Urr \�I tom/ ❑Cwcume2 <br /> Hazardous Waste C]IMW <br /> Tiered Purmltted Feclllly 2 <br /> MAbovegmund Tank <br /> ,gUST (Monitoring/Removal) ❑PWS <br /> gHacardovs Materials a <br /> Spill I Release Response n'•n Qu.m <br /> Solid Waste Facility/Vehicle 4 - <br /> Food Facility <br /> Pool/Spa it Mlnannfa <br /> L]Dalry a f(/ <br /> Land Use Application Sttes .�--. <br /> Septic Pumper Truck/ ❑H...G <br /> 6 <br /> Yard/Chemical Toilets <br /> E Wastewater Treatment Plant UICUPA <br /> Housing Abatement ASTIHM/HW <br /> F1 Molel[Hotel <br /> ❑Chicken Ranch/Dog Kennel cuPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattcdeody Piercing <br /> F-1 Waste Tire a ❑Soup Wase <br /> E]Complaint <br /> n Other(Please Specify): p ACCOeNTNG <br /> 10 <br /> —BOXED AREA-EHD USE ONLY—' <br /> VA Nor, (!u, itr•,2 /L- cit- I njjtA tel. esu - w2, tL041 i <br /> Ll(2 Q'Jl� <br /> I- <br /> - '0 Records provided by Staff-PPR Complete, staff Name: END4s-pa <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 454-0138 1 wytrw.Sjcehd.com <br /> Received Thine Dec. 28. 2017 10:46AM No. 2795 <br />