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- SAN J RECEIVEDVI <br /> A OAQUIN DEC t Zoll ronmental Health Department <br /> —COUNTY— QnPl f LIC RECORDS RELEASE APPLICATION <br /> • Greotne55 CFOW3 he OMRONME.AfTAL tIL4L}li <br /> �IMOUSEtx�ES '1-1`1 EHD LOG NUMBER: 7 <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITY/STAT%/ZIP:—Citrus Heights CA 95611 <br /> PHONE (1): 916-385-0202 PHONE(2): FAX OR E-MAIL: kirstinh(a)gsienvironmental.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 APPLICANTAA;Z) DATE 12/11/17 <br /> 1. List un to ten addresses in the spacfF 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 /> A\�\� 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. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT p ) EHD USE ONLY <br /> FILES (Specific addresses onl ,atltlress ranges will not be acce tetl <br /> Undergrcu nk(UST) Street# Street Name City <br /> Cleanup SRe(LOP) 1 []CO-SWEa <br /> Other Cleanup Site(Non-LO ' 724 E Grant Line Road Tracy (,j �/AAIQI ,Q_ <br /> . Hazardous Waste ❑DAM <br /> Rf Tiered Permitted Facility 2 8715 Grant Line Road W Tracy <br /> RrAboveground Tank <br /> [BUST (Monitoring/Removal) PWS <br /> Hazardous Materials a 2401 NMacArthur Drive Tracy -r- <br /> Spill/Release Response 1 1 <br /> Solid Waste Facility/Vehicle q <br /> ArER QUALITY <br /> ❑Food Facility <br /> Pool/Spa ire MmWnON <br /> Dairy 5 �7 n <br /> ❑Land Use Application Sites <br /> ❑Septic Pumper Truck/ 6 ❑Housirve <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant - CUPA <br /> Housing Abatement 7 AST/HM IHW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel UFA <br /> ❑Medical Waste Facility 6 <br /> UST <br /> Tattooleody Piercing <br /> Waste Tire g OLID WASTE <br /> complaint <br /> Other(Please SpecRy): p A.OUrrING <br /> 1a <br /> ------------------ <br /> ***BOXED AREA-EHD USE ONLY*** <br /> • - �^� �hu�l �he� recon d <br /> 00 N 0 <br /> Co 0039115cs CO o0 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: oxo aaaa <br /> 1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />