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RECEIVED <br />SAN JOAQUIN JUN ° r 2018 Environmental Health Department <br />• C 0l 11',1 T Y ENVIRONMENTALHEALTHPUBLIC RECORDS RELEASE APPLICATION <br />PERMIT/SER PWa <br />IT BY EMAIL <br />7,4ffiEHD LOG NUMBER: V l <br />APPLICANT: Justin Bauer BUSINESS/AGENCY: Trileaf Environmental <br />• <br />• <br />ADDRESS: 2121 West Chandler Boulevard 9108 CITY/STATE/ZIP: Chandler, AZ 85224 <br />PHONE (1): 48-850-0575 PHONE (2): FAX OR E-MAIL: j,bauer@trileaf.com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact y u to arrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT DATE T,,, 4, Z O/ Y <br />1. List up to ten addresses int 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 infoRsicehd.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. t� <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: Z List Z Map — Description: 1 <br />Specific Date Range of Information Requested: From of/oyl9oo to 06/07/2018 <br />ENVIRONMENTAL <br />FILE ADDRESS <br />/I CD -+Ca Ile <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />only, address ranges will not <br />y 9 <br />be accepted) <br />p <br />EHD USE ONLY <br />7x Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />1 <br />2050 <br />Fremont St. <br />Stockton <br />❑ CONSUMER <br />QX Other Cleanup Site (Non -LOP) <br />Z Hazardous Waste <br />p DAIRY <br />Q Tiered Permitted Facility <br />2 <br />Q Aboveground Tank <br />/ , <br />-ti" l 1-1y,/ X151 �v i • w <br />7�t.l�Sy� <br />E] PWS <br />Fx UST ((Monitoring / Removal) <br />XQ Hazardous Materials <br />3 <br />� <br />(�,j�r�•zt,�, f,1��Kw� <br />L �l <br />Z Spill / Release Response <br />/�Vn�•\�Ji <br />1��� <br />WATER QUALITY <br />Q Solid Waste Facility / Vehicle <br />4I"=/w� <br />7 Food Facility <br />� <br />IW7 - Q�LR <br />Q-1-A0 <br />SITE MI <br />Pool / Spa <br />Pool <br />❑ Dairy <br />5 <br />Land Use Application Sites <br />6, <br />❑ HOUSING <br />QX Septic Pumper Truck / <br />Yard / Chemical Toilets <br />Q Wastewater Treatment Plant <br />CUPA <br />F] Housing Abatement <br />7 <br />AST/ HM I HW <br />Motel/Hotel <br />/ <br />tR(CUPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />e <br />UST <br />Tattoo/Body Piercing <br />©SOLID WASTE <br />Waste Tire <br />9 <br />Q Complaint <br />E] ACCOUNTING <br />Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />W <br />❑ Records provided by Staff -PPR Complete. Staff Name: 'IVFHnan.ng <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />