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RECEIVED <br /> SAN J OA Q U I N or'� 0 r 201416 <br /> nvironmental Health Department <br /> COUNTY- - ck4er 3pr—) PUBLIC RECORDS RELEASE APPLICATION <br /> C r G c.:r,' PEPWITYSERME9 <br /> EHD LOG NUMBER: <br /> APPLICANT: Heather Crotty BUSINESS/AGENCY; eScreenLogic <br /> ADDRESS: 11249 Gold Country Blvd.,Ste.165 CITYISTATEIZIP: Gold River,CA 95670 <br /> PHONE(1): 916-288-8174 PHONE (2): FAX OR E-MAIL: h.crotty@escreenlogie.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you toarrange anappointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE 1217117 <br /> 1. List up to ten addresses in the space below. Address ages 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 /> 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 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> Ej Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) CONSUMER <br /> 1 9097- Mariners Drive Stockton <br /> Other Cleanup Site{Non-LOP) <br /> Hazardous waste <br /> El Dniry <br /> Tiered Permitted Facility 2 fi "v(f(' <br /> F]Aboveground Tank 4[� <br /> I]UST (Monitoring 1 Removal) r� l C7 PSS <br /> �Hazardous Materials 3 <br /> Spill I Release Response <br /> ❑W uaGluALiry <br /> Solid Waste Facility 1 Vehicle 4 <br /> Food Facility <br /> Pool I Spa TE MITISATION <br /> ©airy 5 <br /> Land Use Application Sites - �� �..r� —I �? %A <br /> Septic Pumper Truck! 6 p HOUSING <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant UPA <br /> ❑Housing Abatement 7 AST 1 HM 1 HW <br /> ❑Motel/Hotel <br /> F Chicken Ranch/Dog Kennel Cf1PA <br /> 8 <br /> ❑ Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing [i SOLID WASTE <br /> Waste Tire g <br /> F]Complaint <br /> ❑Other(Please Specify): []AOCOUN71NG <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> • 5 — + �,-Ill Gk . 1 ✓A'cep.9� C r'jZ f-hei L A bah „:t 31 <br /> Records provided by Staff-PPR Complete. Stats Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34, F 209 46/445138 1 www.sjcehd.com <br />