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311-111,r- <br /> -VpFT "A"t"`!V'E H';*11j � <br /> • SAN .IOAQUiN COUNTY • EHD LOG NUMBER <br /> M!%1 4 Z L01� ENVIRONMENTAL HEALTH DEPARTMENT %J11 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NpI11LFqgVlpflsu�'F Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> pEwuram 11 ' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services Inc <br /> ADDRESS: PO Box 4517 CITY/STATEIZIP: Citrus Heights, CA, 95611 <br /> PHONE(1): (916)385-0202 PHONE(2): (856)229-7018 FAX OR E-MAIL: kirstinh@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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-,,$/1139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT K�t.�,.v WjV DATE 5/22!17 <br /> 1. List up to ten addresses in the space Belo . elect 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 It 0) <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$139 deposit prior to review. 5/31 <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 1940(or eadiest developement) 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) NSUMER <br /> j1 1111 Navy Drive Stockton <br /> OTHER CLEANUP SITE(NON-L Iid <br /> ��T/ 1JRAr1 <br /> HADIRDOUS WASTE fy V - ❑DNRY <br /> -� <br /> TIERED PERMITTED FACILITY 2 <br /> 9f ABOVEGROUND TANK P <br /> WS <br /> �7-j�l�7 <br /> UST (MONITORING/REMOVAL) ✓t9/ ❑ <br /> HAZARDOUS MATERIALS 0 <br /> E�I`SPILL/RELEASE RESPONSE <br /> WATER DUPLItt <br /> SOLID WASTE FACILITY/VEHICLE <br /> FOOD FACILITY <br /> ❑POOL/SPA //p//—�/r SITE MITGATION <br /> ❑DAIRY <br /> BLAND USE APPLICATION SITES V <br /> /� �HOu51rvG <br /> SEPTIC PUMPER TRUCK/ S (��, ' /' ' /t/h,/) <br /> /l•� <br /> YARD/CHEMICAL TOILETS 11 � � �/ eY/-•i/ ( /) <br /> ❑❑WASTEWATER TREATMENT PLANT ) / 51^ A4-01 <br /> UPA <br /> HOUSING ABATEMENT r V 'yGv}1/C`1y+ ` <br /> yMOTEL/HOTEL <br /> CUPA-UST <br /> JZ CHICKEN RANCH/DOG KENNEL <br /> M MEDICAL WASTE FACILITY B <br /> TATTOD/BODY PIERCING . OUD WASE <br /> YWASTETIRE <br /> 9 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ACCWMING <br /> 10 <br /> ""BOXED AREA-EHD USE ONLY... <br /> 1"C'r"e <br /> ❑ Records provided by Staff-PPR Complete. Starr Name: <br /> EHD 4&06 <br />