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RECEIVED <br /> SAN J OA Q U I N t"lAy 3 -9 211tnvironmental Health Department <br /> - -- C O U N T Y- PUBLIC RECORDS RELEASE APPLICATION <br /> J llJW 0 .N.�AL HEALTH <br /> (.7rC'Cii"itL'SS :1?b•l: �:C�t <br /> EHD LOG NUMBER: ( VT02. <br /> APPLICANT: Lyna Black BUSINESS/AGENCY:Jacobs <br /> ADDRESS: 2525 Air Park Drive CITY/STATEIZIP:Redding,CA 96001 <br /> PHONE(1): 530-229-3295 PHONE(2):530-680-5276 FAX OR E-MAIL: lyna black@lacobs.corn <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac you for a an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List un to ten addresses in the 4pace below. Address ranges WILL NOT be accepted. Select the typ (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 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. <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 i:�<V OC;-Z r _��r i to 4t r tr <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Silo(LOP) .AMW'4 CONSUWER <br /> J2 Other Cleanup Site(Non-LOP) t Q <br /> PHazordoua Waste __� ❑p�H. <br /> E]Tiered Permitted Facility 2 <br /> ' -Aboveground Tank J til q r-' 'rt (AWbi NA S �( p <br /> 180 <br /> _Ca <br /> -UST (Monitoring/Removal) C3 Pws <br /> ®Hazardous Malodals 3 n T ST <br /> ®;Spill/Release Response 2� �� +C�' C�, its�,,,i �� ; DR <br /> El Solid Waste Facility/Vehic[e Wall: <br /> F �S� - UTERO ALITY <br /> ❑Food Facility �t7 r t� L L4i a D <br /> Pool/Spa NM i{11 <br /> 0'§17.MITIOATION <br /> Dairy i `` k\ i <br /> E]Land Use Application Slfes��[I it? J p \t �T <br /> Septic Pumper Truck/ R r) I�'t it�I-HM8P, <br /> ❑HOS' <br /> Yard I Chemical Toilets if `^J ('-, <br /> Wastewater Treatment Planty� J µM v y CC-­' UPA <br /> F1 Hous/ Abatement - �`1�y1 ' \�k�V ASTIHMIHW <br /> F1MoleUHotelHolul V ` J . TOP Z' <br /> ❑Chicken Ranch/Dog Kennel ig COPA <br /> n Medical Waste Facility e I UST <br /> []Tattoo/Body Piercing <br /> Waste Tire SOLID WASTE <br /> e <br /> complaint <br /> I <br /> Other(Please Specify) C]AccouNTINO <br /> to <br /> i <br /> • BOXED AREA-EHD USE ONLY— <br /> 2 &D PP_05h7I'G1_ <br /> +� UUv tt Zq Pn Cie <br /> D R cords provided by Staff-PPR Complete. staff Name: LCD G laHD4a-0s <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />