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RECEIVED <br /> SA10AQUIN Environmental Health Department <br /> •'1 � —COUNTY— DEC j 2017 PP LIC RECORDS RELEASE APPLICATION <br /> •F 1r " <br /> Greatness crews he£PflFlRONMEKTALfL-'}}{ 7 <br /> • F'f=R�i1(P/uE9 lit-11 EHD LOG NUMBER: 1 <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITY/STAB/ZIP: Citrus Heights, CA 95611 <br /> PHONE(1): 916-385-0202 PHONE(2): FAX OR E-MAIL: kirstinh@gsienvironmental.com <br /> Please allow 10 business days from data 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 APPLICANT 94 ,� DATE 12/11/17 <br /> 1. List up to ten addresses in the spat 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.� 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:OOPM(EXCLUDING HOLIDAYS)11 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p g accepted) EHD USE ONLY <br /> FILES (Specific addresses onl address ran es will not be acce ted <br /> Undergrou nk(UST) Street# Street Name city --- <br /> Cleanup Site(LOP) 1 ❑CoesunnEn <br /> Other Cleanup Site(Non-LO 724 E Grant Line Road Tracy 1,1YIAYAA1A/�,Q_ <br /> • V Hazardous Waste [:I DAIW <br /> Tiered Permitted Facility Z 8715 Grant Line Road W Tracy - <br /> VAboveground Tank <br /> VUST (Monitoring/Removal) 21 ❑PWS <br /> r Hazardous Materials a 2401 N MacArthur Drive Tracy Wow �� T C <br /> Spill/Release Response <br /> VSolid West.Facility/Vehicle 4 ATEROWBT✓ <br /> ❑Food Facility <br /> ❑Pool/Spa ire Mm.Anoe <br /> ❑Dairy 5 <br /> ❑Land Use Application Sites <br /> ❑Houem <br /> Septic Pumper Truck/ a <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUP, <br /> ❑Housing Abatement 7 AST/HM IHW <br /> ❑Motel/Hotel <br /> Chicken Ranch I Dog Kennel UPA <br /> 8 UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing ouo WASTE <br /> Waste Tire 9 <br /> Complaint <br /> Other(Please Specify): ❑Acmuttnns <br /> to <br /> ***BOXED AREA-EHD USE ONLY <br /> • 1^1 —tZh,0 " net, re Ce# 0 n ;ne ( a4 ►a (ie . M <br /> 00 I 0 <br /> Co 0 0 -3 91155 CO DO <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: BHD 4a.os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br />