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To: 12094640138 From: 19164800603 Date: 11/09/16 Time: 12:54 PM Page: 01/01 <br /> i DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 'r RECEIVE® ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV g Q 1868 East Hazelton Avenue, Stockton, CA 95205-6232 8 5a�� <br /> 7gi phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTALHEALT�UBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERVIr.Fc <br /> APPLICANT: Erin Basel BUSINESS/AGENCY: ENERCON <br /> ADDRESS: 80 Blue Ravine CITY/STATEIZIP: Folsom, CA 95630 <br /> PHONE (1): 916-930-9565 PHONE(2�mai1: ebasel@enercon.WCSIMILE: 916-480-0603 <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-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Nov 9, 2016 <br /> Electronic Information: ❑ List ❑ Map -Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 4274 Pock Lane Stockton <br /> ❑ Unit 1 <br /> 3. 5dUntt 2 <br /> 4. <br /> ❑Unit 2H <br /> 5. i <br /> I U Unft 3 <br /> LT <br /> SITE MITIGATION <br /> Unit 5 <br /> Specific Date Range of Information Requested: From Any/All to Any/All <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑+ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ©SOLID WASTE FACILITYIVEHICLE <br /> X❑OTHER CLEANUP SITE(NON-LOP) - ❑HoUSINGA13ATEMENT Q WASTE TIRE <br /> Q UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL X WASTEWATER <br /> © ❑ ❑ TREATMENT PLANT <br /> ❑Y. HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDIC HEMICAL TOILETS <br /> X❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING Q COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above 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(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$130 deposit prior to review. 'BOXED AREA- EHD USE ONLY'*` <br /> eN <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Time—Nov. 9. '2016-12:51PMTNo. 0325 <br />