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0 <br />RECE IVE D� J SANEHD LOG NUMBER <br />.IOAQUIN COUNTY <br />DEC ��� �.%� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />RON TF� <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd q77(3 <br />eFraluITr.S6fMiiC;E9 R PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Kathryn Smith BUSINESSIAGENCY: AEI Consultants <br />ADDRESS: 520 3rd Street, Suite 209 CITY/STATE/ZIP: Oakland CA 94607 <br />PHONE (1): 510-907-3145 ext 2103 PHONE (2): FAX OR E-MAIL:krsmith@aeiconsultants.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 />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <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. A <br />Future file reviews by the same applicant may require a $130 deposit prior to review. 12/O„Zq <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: F-1 List F1 Map — Description: <br />Specific Date Range of Information Requested: From May 2017 to Present <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />® UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />city_ <br />1 <br />���+yp� <br />' 6 <br />A c <br />AtAN.k ){ <br />�,' l' <br />6+oto<`0v, <br />tk El CONSUMER <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE(NON-LOP) <br />HAZARDOUS WASTE^ <br />® TIERED PERMITTED FACILITY <br />2 <br />54t) <br />A' Ar' <br />/ DNw <br />® ABOVEGROUND TANK <br />! <br />3 <br />`113117 <br />s <br />rtet—,&t 51.L <br />I( <br />PWS <br />MUST (MONITORING/REMOVAL) <br />HAZARDOUS MATERIALS <br />CJ`�Ijjjj <br />•"`V <br />SPILLIRELEASE RESPONSE <br />❑ SOLID WASTE FACILITY/ VEHICLE <br />4 <br />Int <br />I <br />QUALITY <br />` <br />�� <br />t �ATEH <br />❑ FOOD FACILITY <br />6 <br />FfCth�T <br />f <br />A�T I1E MmGATGN <br />1•r TT <br />❑POOL/SPA <br />❑DAIRY <br />V-1 <br />— <br />❑ LAND USEAPPLICATION SITES <br />I <br />❑ HOUSING <br />❑ SEPTIC PUMPER TRUCK IS <br />YARD/ CHEMICAL TOILETS <br />��� <br />PCAA-kLG <br />I <br />/! <br />❑ WASTEWATER TREATMENT PLANT <br />IJ465W 6/l/ UPA <br />10((I� b/ <br />❑ HOUSING ABATEMENT <br />7 <br />t! <br />❑ MOTEL/HOTEL <br />CHICKEN RANCH/DOG NEL <br />B <br />�yL <br />��(���/.(� <br />/Y )C <br />O UPA -HAZ-MAT <br />❑ MEDICAL WASTE FACILI <br />/I <br />❑ TATTOGIBODY PIERCING <br />SOLID WASTE <br />❑ <br />❑ WASTE TIRE <br />❑ COMPLAINT <br />❑ ACCOUNDNG <br />❑ OTHER(PLEASE SPECI%): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />L,aL r�ALP, rA.4,cvot -f r.: <br />Staff Name: <br />r■ <br />..i .B.dlrrr, <br />