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1T!I1k1nrL"j'V r-U <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> APR <br /> ENVIRONMENTAL HEALTH DEPARTMENT �J V7� <br /> Pit K rJ ��` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 jJ <br /> Tele hone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.com Email: info(&sicehd com <br /> ftWRONMEAffAL l-tF 371 <br /> rsEMAIr/gEsz E9 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Emily Kern BUSINESS/AGENCY: ERM <br /> ADDRESS: 114 Sansome St, Ste 750 CITY/STATE/ZIP: San Francisco,CA 94104 <br /> PHONE(1): 628-221-7833 PHONE(2): 267-269-3965 FAX OR E-MAIL: Emily.Kem@erm.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-$139 FEE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed by Staff. DSM DATE April 5 2017 <br /> 1. List un to ten addresses in the space below. Address ranges will not be accepted. Select the type(s)of files from the list <br /> 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 above,or email to info(a)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 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. f, <br /> Future file reviews by the same applicant may require a $139 deposit prior to review. _I /13 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) l <br /> Electronic Information: ❑ List❑ Map— Description: <br /> Specific Date Range of Information Requested: From to _ <br /> 7CL�UP <br /> ONMENTAL FILE ADDRESS <br /> DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> UND TANK(UST) Street# Street Name City <br /> UE(LOP) �CONSUMER <br /> ANUP SITE(NON-LOP t14800 W Schulte Rd Tracy <br /> WASTE ❑DAIRY <br /> MITTED FACILITY 2 <br /> ®ABOVEGROUND TANK <br /> ®UST (MONITORING/REMOVAL) PWS <br /> ®HAZARDOUS MATERIALS 3 <br /> ®SPIU(RELEASE RESPONSE <br /> ®®SOLID WASTE FACILITY/VEHICLE d WATER QUALITY <br /> FOOD FACILITY <br /> OPOOL/SPA '(y'/Tyrol 1 U (I®SITE MI"ON <br /> DAIRY E 11 A <br /> LAND USE APPLICATION SUES <br /> F1 SEPTIC PUMPER TRUCK/ B ❑HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT ®CUPA <br /> n HOUSING AMTEMENT T <br /> ❑MOTEL/HOTEL <br /> CHICKEN RANCH/DOG KENNEL IR CUPA-UST <br /> MEDICAL WASTE FACILITY B <br /> TATTOO/BODY PIERCING <br /> ❑WASTE TIRE 9 ®SOLID WASTE <br /> ®COMPLAINT <br /> OTHER(PLEASE SPECIFY): <br /> 70 ❑Accaunnxc <br /> e' "`BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br />