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ECE IVE J SANEHD LOG NUMBER <br /> .IOAQUIN COUNTY <br /> DE <br /> 4 � �� �.� 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 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. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. I2 o(C� <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 May 2017 to Present <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name City_ <br /> CLEANUP SITE(LOP) A _ El CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) 1 a•/ A AN.-k�'� 6+ot4<`0vjHAZARDOUS WASTE ^ / DMm' <br /> ®TIERED PERMITTED FACILITY 2 ��(� A'Ar' <br /> ®ABOVEGROUND TANK ! <br /> ® <br /> LIST (MONITORING/REMOVAL) []PWSHAZARDOUS MATERIALS 3 `113117 <br /> CJ`�Ijj{{s rtet—,&t 51.L (( • "`V <br /> SPILLIRELEASE RESPONSE <br /> ❑FOOD <br /> WASTE FACILItt/VEHICLE 4 `fit �� ) �t 911 QUALITY <br /> F000 FACILITY ` <br /> ❑POOL/SPA f A�T I1E MmOwnev <br /> ❑DAIRY 6 V-1 FfCth�T - 1•r TT <br /> ❑LAND USEAPPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ S ) I ❑HOUSING <br /> YARD/CHEMICAL TOILETS PCAA-kLG /! <br /> ❑WASTEWATER TREATMENT PLANT '��^L ' � IJ465W aAl( UPA <br /> ❑HOUSING ABATEMENT 7 V 10((I�b/ <br /> ❑MOTEL/HOTEL <br /> CHICKEN RANCH/DOG NEL B �yL ��(���/.(� /Y)C O /I UPA-HAZ-MAT <br /> ❑MEDICAL WASTE FACILI Y Lv ^ <br /> ❑TATTOGIBODY PIERCING �//� )� �t SOLID WASTE <br /> ❑WASTE TIRE y `a 5 !n"in ❑ <br /> ❑COMPLAINT <br /> OTHER(PLEASE SPECI%): ❑ACCOUNDNG <br /> 10 <br /> • ***BOXED AREA-EHD USE ONLY*** <br /> -'10^i C-f�M1 e� IA:�e,j' -f,.—A ..i k e QttSURKt,L <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> END 4e-os <br />