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[VIM" MA, <br />SAN ,J O A Q U I N 41AY 3 0 z2bliEnvironmental Health Department <br />-- C U- LI N T Y---- PUBLIC RECORDS RELEASE APPLICATION <br />10Ed±R/i ONWI :rAL I-fEAt.� i I <br />��_ J� <br />rcntncss c, 7sys :sere. /l .G. <br />Alt EHD LOG NUMBER: (3v 02 <br />APPLICANT: Lyna Black _ BUSINESS/AGENCY: Jacobs <br />• <br />0 <br />ADDRESS: 2525 Air Park Drive CITYiSTATEIZIP: Redding, CA 96001 <br />PHONE (1): 530-229-3295 PHONE (2):530-680-5276 FAX OR E-MAIL: lyna.black@jacobs.com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contac you for a an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT DATE so tis <br />1. List up to ten addresses in the pace below. Address ranges WILL NOT be accepted. Select the typb(s) of files from the <br />list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138, mail to the <br />address indicated below, or email to lnfo@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:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From =<;r i t -,.It c+,_L r -k to <br />ENVIRONMENTAL <br />DEPARTMENT <br />�7t <br />FILE ADDRESS <br />l <br />®R cords provided by Staff -APR Complete. Staff Name: <br />�%) L CQ � QHD 4946 <br />FILES <br />(specific addresses <br />only., address ranges will not <br />be accepted) <br />EHD <br />USE <br />ONLY <br />Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />,' n <br />Nl <br />CQNSUWER <br />Cleanup Silo (LOP) ' <br />J2 Other Cleanup Site (Non -LOP) <br />- <br />- - <br />(Hazardous Waste <br />YE] <br />,,,� _ <br />>Ir1 <br />❑ PuH+ <br />Tiered Permitted Facility <br />Aboveground Tank <br />2 <br />�� <br />J til r; C t { (Z S <br />• }( <br />�, <br />UST (Monitoring I Removal) <br />-. <br />PWS <br />® Hazardous Materials <br />❑} .Spill / Release Response <br />1 <br />2 p , ., <br />1 �� <br />^�- ._ � <br />j { °' k ("'^ <br />� <br />1 <br />✓t�'J i !rATEn <br />!] ALitY <br />E] Solid Waste Facility / Vehic:a <br />❑ Food Facility <br />�D i <br />_ <br />� {� L n A f ��l <br />• <br />o D <br />i <br />NtY,>;, ,�; <br />®`SIT'c Fv11TtGA1lON <br />❑ Pool I SpA <br />® Dairy <br />5 <br />k <br />Land Use Application Sltas <br />Aa <br />p <br />r) <br />*i ±ski <br />HOUSING <br />® Septic Pumper Truck 1 <br />Yard I Chemical Toilets _ <br />-T(, <br />f ( <br />Q <br />dJ <br />+ �0 <br />L f vv ot7-j <br />I1 Y Y <br />[:j Wastewater Treatment Plant` <br />I^ '� <br />B;rcUPA <br />❑ Housing Abatement <br />ASTIHMIHW <br />❑ MoleUHotel <br />lD <br />[2'CUPA <br />Chicken Ranch I Dog Kinnel <br />Medical Waste Faculty <br />a <br />UST <br />❑ Tatiool6ody Piercing <br />[] Waste Tire <br />9 <br />p SouowAstr: <br />❑ Complaint <br />Other (Please Specify) <br />C] AccouNTINa <br />to <br />BOXED AREA -_EHD USE ONLY - <br />1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />�7t <br />0P0cz7j1 <br />l <br />®R cords provided by Staff -APR Complete. Staff Name: <br />�%) L CQ � QHD 4946 <br />1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />