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• <br />SAN .J QAQ U N MAY 3 0 2111Environmental Health Department <br />i 01 Li _ — - C 0 U N T Y--•— PUBLIC RECORDS RELEASE APPLICATION <br />+)�A <br />E�AIQhtfil�,;�,r, Ai HEALTH �I _ Jd <br />Greatness ;rows hcrc i'ENMI I�-L' <br />AIL� <br />y-pA EHD LOG NUMBER: g(jT02. <br />APPLICANT: Lyna Black <br />BUSINESS/AGENCY: Jacobs <br />ADDRESS: 2525 Alr 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 cantac you to, a an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT Y ' DATE <br />1. List up to ten addresses in the race below. Address ranges WILL NOT be accepted. Select the typ (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 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:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From { ; t t- r} C{ .t� _ to r� �, (SaA. <br />ENVIRONMENTAL <br />FILE ADDRESS <br />yCl� <br />lU�2y I� <br />HEALTH DEPARTMENT <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 />i, <br />❑ CONSUWEP. <br />Cleanup Site (LOP) <br />2 Other Cleanup Site (Non -LOP) <br />i r+,iZ� <br />��. �, - { <br />"`-� <br />'^� <br />'-�1 <br />Cl [1�14r <br />Hazardous Waste <br />E] Tiered Permitted Facility <br />2 <br />/� r <br />'M�r,tir t-1 (is <br />•�t <br />N') O <br />�AbovegraundTank <br />�;� <br />mT <br />❑PWS <br />UST (Monitoring i Removal) <br />s <br />Hazardous Mafedals <br />np <br />f-13 <br />Tc <br />p <br />i <br />®Spill / Release Response <br />LVIATERt] ry <br />❑ Solid Waste Facility / Vehlcta <br />^� <br />w <br />F1Food Facility <br />r0 r <br />(.t�' L n A fi <br />___ <br />i N o D- <br />,S <br />Pm K{ : <br />Q'S TE tnr�+no+ <br />❑ Pool / Spa <br />❑ Dairy <br />d <br />_ i.. <br />L( <br />�� <br />i <br />.0 <br />Land Use Application Sites <br />^ <br />(� <br />' <br />❑ H' <br />❑Septic Pumper Truck / V\ ^ <br />Yard I Chemical Toilets V <br />2&'j <br />Jt;� <br />S• -T(,,, b�. <br />144MM <br />(' t' "' t/� <br />® Wastewater Treatment Plant ` - <br />NM NW <br />©'CUPA <br />E] Housing Abatement <br />�t <br />ral� � <br />� <br />ASTIHMIHW <br />® MoteUHoioi <br />®`COPA <br />❑ Chicken Ranch / Dog Ksnnel <br />❑ Medical Waste Facility <br />p <br />UST <br />Tattoo/Body Plarcing <br />❑ SCUD WASTE <br />Waste Tire <br />e <br />❑ Complaint <br />❑ Accou rrwa <br />❑ Other (Please Specify) <br />fa <br />"--UVnt_U AKCA - MMU UAL UNLT <br />V'i. Tt <br />k9 1 Z c rt i PR <br />i U1122A-,9I0 j CQ0 0 ti 2q 1 ' a <br />❑ R cords provided by Staff -PPR Complete. Staff Name: t LY/ I 1-0D $HD4"$ <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />7 <br />