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ECEIVED <br />S A N J O A Q U Environmental Health Department <br />C U N T Y--- JUL 0 �� PUBLIF RECORDS RELEASE APPLICATION <br />• � <br />PEnr _ MAIL 161 2.L4q <br />tiNIR/S � �-� p �� EHD LOG NUMBER: <br />• <br />Is <br />APPLICANT: Tonya Scheftner <br />ADDRESS: PO Box 77 <br />BUSINESS/AGENCY: <br />CITY/STATE/ZIP: Mt. Hermon, CA <br />PHONE (1): 209-770-0731 PHONE (2): FAX OR E-MAIL: tscheftner@petralogix_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 a ap ointment date and time to review the requested records. <br />SIGNATURE OFAPPLICANT �! DATE 7/30/2018 <br />1. List up to ten addresses in the space clow. Addres 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(c�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) , -,,/7 <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />FILE ADDRESS <br />only, address ranges will not <br />be accepted) <br />Cu �I <br />;EHD USE ONLY <br />R Underground Tank (UST) <br />Cleanup Site (LOP)0 <br />0 Other Cleanup Site (Non -LOP <br />Street # <br />Street Name <br />City -- <br />131 <br />N Paeifi c Ave <br />Lod i <br />) coONSUb1ER <br />Q Hazardous Waste <br />Q Tiered Permitted Facility <br />nX Aboveground Tank <br />2 <br />0 DAIRY <br />Q PWS <br />nX UST (Monitoring / Removal) <br />nX Hazardous Materials <br />3 <br />Q Spill / Release Response <br />4 <br />ATER QUALITY <br />Q Solid Waste Facility / Vehicle <br />Q Food Facility <br />53,SrrE MITIGATION <br />0 Pool / Spa <br />n Dairy <br />5 <br />© Land Use Application Sites <br />e <br />11 ROUSING <br />Septic Pumper Truck ! <br />Yard / Chemical Toilets <br />i <br />F1 Wastewater Treatment Plant <br />[g CUPA <br />❑ Housing Abatement <br />7 <br />AST / HM / HW <br />MDteUHotel <br />l CUPA <br />Chicken Ranch / Dog Kennel <br />El Medical Waste Facility <br />8 <br />UST <br />E] Tattoo/Body Piercing <br />❑ Waste Tire <br />a <br />Q Soup WASTE <br />Q Complaint <br />Other (Please Specify): <br />10 <br />Q ACCOUNTING <br />* BOXED AREA - EHD USE ONLY— <br />> I <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 wArw.sjcehd.com <br />