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RECEIVED <br /> SKJOAQUIN <br /> DEC 12 Zai? a <br /> Environmental Health Department <br /> —COUNTY— nP,1UBLIC RECORDS RELEASE APPLICATION <br /> • ,,�`` Greatness crcivs he0fli1R4NJ1L'E4AfiRLfff4ll.?li ?`(^✓(v' <br /> PEMMIUSERVICES It-11 1 EHD LOG NUMBER: ( I <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services, Inc.(GSI) <br /> ADDRESS: PO Box 4517 CITY/STAN/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 date of application submittal for the records to be available. <br /> Staff will contact y�t�rr�ange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT W- 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(&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 /> \X 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 to <br /> ENVIRONMENTAL FILE ADDRESS <br /> ( <br /> HEALTH DEPARTMENT g accepted) EHD USE ONLY <br /> FILES Sp ecific addresses only,address ranges will not be acce ted _ <br /> _._._.._ <br /> Undergrou nk(UST) Street# Street Name City - - <br /> Cleanup Site(LOP) , ' ❑CONSUMER <br /> Other Cleanup Site(Nan-LO 724 E Grant Line Road Tracy 1:1�1(A,1IQ/ — <br /> . EZHazardous Waste ❑DMR/ <br /> Rf Tiered Permitted Facility z 8715 Grant Line Road W Tracyi <br /> Aboveground Tank <br /> ( UST (Monitoring/Removal) � ❑PWS <br /> y�Hazardous Materials a 2401 N MacArthur Drive Tracy Woo/i1 oe <br /> [Spill/Release Response ATER puum <br /> Solid Waste Facility/Vehicle 4 <br /> I]Food Facility <br /> Pool/Spa nE MincAnory <br /> Dairy 6 <br /> ❑Land Use Application Sites —�� HOMING <br /> ❑Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUP, <br /> Fl Housing Abatement 7 AST/HM IHW <br /> El Motel/Hotel <br /> E]Chicken Ranch I Dog Kennel UPA <br /> g UST <br /> ❑Medical Waste Facility <br /> Tattoo/Body Piercing ouo WAere <br /> Waste Tire 9 <br /> 9 Complaint <br /> ❑Other(Please Specify): ❑AcwurvnNc <br /> 10 <br /> •"BOXED AREA-EHD USE ONLY*** <br /> • z-1 —l;r,w 1 hey re cce n a n <br /> iNel, 4 jelid,. ►-¢ Cie M <br /> 00 I NCO <br /> 3S 15 Co 00 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 4&06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />