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ECEIVED <br /> SAN 10AQUIN "SUN 0 r 2018 Environmental Health Department <br /> • C C)l I P-.l T `r" ENVIRONMENT&HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SER OW a0`871ks <br /> S ITBY EMAIL 7�EHD LOG NUMBER: <br /> APPLICANT: Justin Bauer BUSINESS/AGENCY:Trileaf Environmental <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 es 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: E List Z Map—Description: <br /> Specific Date Range of Information Requested: From ovov1900 to 06/07/2018 <br /> ENVIRONMENTAL FILE ADDRESS d cpC4(I� <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY <br /> FILES addresses only,address ran es wilt not be acce ted <br /> ❑x underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUMER <br /> FX Other Cleanup Site(Non-LOP) 1 2050 Fremont St. Stockton <br /> X Hazardous Waste DAIRY <br /> Q Tiered Permitted Facility 2 / , <br /> Q Aboveground Tank I-ti"l 1-1y,/LAL L'v 1.w <br /> ❑X UST (Monitoring/Removal) 7)g4ii;y_ E]PWS <br /> 3 � <br /> X❑Hazardous Materials j�,j�r�•zt,�,�,1��Kw� <br /> X❑Spill/Release Response /�Vn�•\�J`7 L �J p� t/� <br /> Q Solid Waste Facility/Vehicle4 I`4/w�542-40 <br /> � WATER QUALITY <br /> ❑Food Facility AD 2 Q'4m <br /> Pool/Spa SITE MITIGATION <br /> ❑Dairy 5 <br /> ❑Land Use Application Sites ---- <br /> ❑X Septic Pumper Truck/ G ❑HOUSING <br /> Yard/Chemical Toilets <br /> Q Wastewater Treatment Plant (CUPA <br /> ❑Housing Abatement 7 AST/HM I HW <br /> ❑Motel/Hotel / <br /> ❑Chicken Ranch/Dog Kennel tR(CUPA <br /> 8 <br /> ❑Medical Waste Facility UST <br /> ❑Tattoo/Body / <br /> Ty Piercing �SOLID WASTE <br /> ❑Waste Tire 9 <br /> Q Complaint _ <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— tJ <br /> YV <br /> • ` <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 />