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NRECEIV o. <br /> SAN JQAQUI Environmental Health Department <br /> —COUNTY- NOY G 7 ZUIr Iog PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness <br /> • grows h,re dqker 3Jt1 <br /> AL HEALTH <br /> PEMAITAFRR11F1 <br /> EHMBER. <br /> � <br /> APPLICANT: Beniamin Peterson BUSINESS/AGENCY: McGinley&Associates Inc <br /> ADDRESS: 815 Maestro Drive CITY/STATE/ZIP: Reno, NV 89511 <br /> PHONE(1): 775-899-2945 PHONE(2): 775-386-5406 FAX OR E-MAIL: bpeterson((ilmc0ln.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 DATE <br /> 1. List uo 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(&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. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From beginning to present <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 p ) EHD USE ONLY <br /> FILES (Specific addresses only,address ran es will not be acce ted <br /> ❑x Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) [3 CONSUMER <br /> ❑X Other Cleanup Site(Non-LOP f 1010 Industrial Drive Stockton,CA a ly�t <br /> • ❑x Hazardous Waste (I� ❑Dunn <br /> ❑Tiered Permitted Facility 2 <br /> xj Aboveground Tank <br /> K]UST (Monitoring/Removal) O PWS <br /> 3 <br /> Q <br /> Hazardous Materials <br /> Q Spill/Release Response <br /> ® ATEP OnALItt <br /> ❑Solid Waste Facility/Vehicle d <br /> Food Facility <br /> SITE MITIGATION <br /> Pool/Spa Dairy 5 <br /> E] Land Use Application Sites <br /> HOuswO <br /> [j Septic Pumper Truck 1. a <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement Y AST/HM/HW <br /> ❑Motel/Hotel <br /> E]Chicken Ranch/Dog Kennel 5p6UPA <br /> g UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing ❑SOLIO WASTE <br /> Waste Tire g <br /> Q complaint <br /> F]Other(Please Specify): ❑A000nMING <br /> ID <br /> ***BOXED AREA-EHD USE ONLY*** <br /> • II' -t -U-I'l 11e nor/✓T M024if o� NO. nU <br /> ❑ Records provided b Staff-PPR Complete. staff Name: EHo 4e-0c <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />