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� <br /> E <br /> SAN ' OA <br /> Environmental Health Department <br /> � � 9 �0Y8 « l- --[OUNT / <br /> PUBLIC RECORDS RELEASE APPUC&l|[)N <br /> � +« G <br /> ENTALH 'T BY EMAIL 4391 <br /> PEHNIT/8FRWE EHID LOG NUMBER: <br /> APPLICANT: Krisstaniey BUSINESSIAGENCY:Brown and C"m°mn <br /> ADDRESS: 1527 Cole Blvd,suite mm CITY/STATE/ZIP:Lakewood,cOo04o, <br /> PHONE(1): 303-239-5*63 PHONE(2): FAX OnE-MA|L: kstan/ <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 /> SIGNATURE OFAPPLICANT Kris uta / ' <br /> — — ' _-- . <br /> 1. List up-to ten addresses in the space 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 infoPsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance inidentVyingrbanatumanduontentofEHDmnn,du. pleaaecontoo EHDauthe number noted below. <br /> 3. The EHDwill notify the applicant ifany EHofiles exist. Anappointment for review will boonnfimmodapproximately ten(1O) <br /> days after receipt ofapplication. The files will heheld for emaximum offive business days for review. Appointments <br /> should bvscheduled 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 uythe same applicant may require a$1S2deposit prior to n^v|evu <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0:O0AM'5:OUPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: E] List L] Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> FXJ Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) � 1 710 N. Sacramento Lodi El CONSUMER <br /> Other Cleanup Site(Non LOA <br /> 7X Hazardous Waste DAIRY <br /> nx Tiered Permitted Facility 2 <br /> FX�UST (Morftoririg I Removal) El PWS <br /> [XI Hazardous matertals 3 <br /> Rx Spill I Release Response <br /> __ER QUALITY <br /> Solid Waste Facility I Vehicle 4 vmu L 0 rj27WAT <br /> F] Food Facility <br /> Land Use Application Sites A <br /> HousNo <br /> Septic;Pumper Truck I <br /> Yard I Chemical Toilets <br /> F-1 Wastewater Treatment Plant (�31'cu A <br /> Housing Abatement 7 STlHMlHW <br /> F]Chicken Ranch I Dog Kennel 8 (2p'yyj6 U'4-'t VC''PA <br /> F7 Medical Waste Facility UST <br /> Waste Tire 9 <br /> F-]complaint <br /> other(Please specify): AccouNTIN I <br /> El Records provided by Staff-PPR Complete. Staff Name: EHD 4M6 <br /> 1888E. Hazelton Avenue I Stockton, California 9S2O6T 209489-34201 P 209 464-0138 1 vmww.sjcehd.onm <br />