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RECIE'VE <br /> -�- SAN J O A Q U J N nvironmental Health Department <br /> ---COUNTY-- HAY 1 2018 PUBIC RECORDS RELEASE APPLICATION <br /> , <br /> • GreGreatness Craws here—_NVIRrJNME �bll�'I±6vlAlL �`qApA <br /> PERMIT/S EHD LOG NUMBER. <br /> APPLICANT: John Sellman BUSINESS/AGENCY:ATC Group Services,LLC <br /> ADDRESS: 1117 Lone Palm Avenue,Suite 201B CITY/STATE/ZIP:Modesto,CA 95351 <br /> PHONE(1): 209-579-2221 PHONE(2):209-872-5291 FAX OR E-MAIL: john.sellman@atcgs.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 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 info(a-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. t <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) 1 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From any to <br /> ENVIRONMENTAL FILE ADDRESS IC-D <br /> HEALTH DEPARTMENT ( p y g accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> 0 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) 11 CONSUMER <br /> x❑Other Cleanup Site(Non-LOP) 1 2{��5� N. MacArthur Dr. Tracyi <br /> 0 Hazardous Waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> Q Aboveground Tank <br /> gAM RW kia5T <br /> I]UST (Monitoring/Removal) ❑PWS <br /> 3 r <br /> Hazardous Materials /�0���«_ Z �/+► <br /> Spill/Release Response1� v1� �f WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 Pao 1;1Q` `-1I—�_ <br /> Food Facility L —�� <br /> SITE MITIGATION <br /> Pool/Spa <br /> ❑ Dairy 5 <br /> ❑Land Use Application Sites <br /> ❑HOUSING <br /> ❑Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> CUPA <br /> Chicken Ranch/Dog Kennel <br /> 8 UST <br /> Medical Waste Facility <br /> F]Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY"" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 48-0e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />