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RECEIVED <br />SAN J 0AQ U 1 N4,u6 01 20181 Environmental Health Department <br />COUNTY-- <br />OUNTY--PUBALJ�III <br />C RECORDS RELEASE APPLICATION <br />W�4)NRENT�7BY EMAILPEMIT/8Et�OWIT­ <br />A/� <br />&2 EHD LOG NUMBER:9 - Q L <br />APPLICANT: Justin Bauer <br />BUSINESS/AGENCY: Trileaf Environmental <br />ADDRESS: 2121 West Chandler Boulevard, suite 108 CITY/STATE/ZIP: Chandler, AZ 85224 <br />PHONE (1): 480-8s0-0575 PHONE (2): FAX OR E-MAIL: i-bauer@trileaf.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 Justin Bauer - DATE <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 infoPslcehd.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)- "1f <br />I Electronic Information: x0 List ❑X Map — Description: I <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />CC) X Ix <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />onlyaddress ran es will not <br />y 9 <br />be acce ted <br />p ) <br />EHD USE ON Y <br />❑X Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />❑X Other Cleanup Site (Non -LOP) <br />' <br />1950 <br />West Fremont <br />Stockton <br />i 1114. e <br />�► <br />1 r ❑ CONSUMER <br />�m <br />X Hazardous Waste <br />K t <br />�, o "� <br />❑ DAIRY <br />Q Tiered Permitted Facility <br />z <br />2010 <br />West Fremont <br />Stockton <br />Rely <br />ZX Aboveground Tank <br />❑ PWS <br />❑X UST (Monitoring / Removal) <br />❑X Hazardous Materials <br />3 <br />❑X Spill / Release Response <br />4 <br />WATER QUALITY <br />❑X Solid Waste Facility / Vehicle <br />Food Facility <br />VIT. MITIGATION <br />Pool / Spa <br />❑ Dairy <br />5 <br />❑X Land Use Application Sites <br />6 <br />E] HouslNc <br />F1 Septic Pumper Truck / <br />Yard / Chemical Toilets <br />❑ Wastewater Treatment Plant <br />W16UPA <br />❑ Housing Abatement <br />7 <br />AST/HM/HW <br />❑ Motel/Hotel <br />UPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />Tattoo/Body Piercing <br />SOLID WASTE <br />Waste Tire <br />g <br />❑X Complaint <br />❑ ACCOUNTING <br />Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />01 <br />L 71 <br />OW11100112MI 0111 110E. ST Eft,7TWO <br />ma <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />