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RECEIVED <br /> SAN J U A Q U I N MAR 2 0 2018 Environmental Health Department <br /> C O U N T Y 7� PUBt IC RECORDS RELEASE APPLICATION <br /> ENVIRONME EMAIL y�t�\ <br /> • PERMIT/ EHD LOG NUMBER: <br /> APPLICANT: Megan Davey BUSINESS/AGENCY:Terracon Consultants <br /> ADDRESS: 50 Goldenland Court,Suite 100 CITY/STATEOP:Sacramento,CA 95834 <br /> PHONE(1): (916)246-5097 PHONE(2):(916)928-4690 FAX OR E-MAIL: Megan.Davey@terracon.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 /> SIGNATURE OF APPLICANT ; n ' DATE 3-20-18 <br /> 1. List up to ten addresses in the space;below. Address anges 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(2091464-0138,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) 3`Zr�, <br /> v <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y y p <br /> FILES (Speck addresses only, ranges will not be accepted) EHD USE ONLY <br /> ❑x Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) n 0 Conswm <br /> Other Cleanup Site(Non-LOP I 321 Spreckles Avenue Manteca <br /> • Qx HazaldDee Waste r <br /> OTiered PermiftedFacility z PN: 221-210-200A`fl,NMrl-iW ❑Dnwy <br /> QX Aboveground Tank <br /> I?]UST (Monitoring/Removal) [7 PWS <br /> 0 Hazardous Materials a <br /> Spill/Release Response <br /> I]Solid Waste Facility/Vehicle 4 ATUt Duum <br /> ❑Food Fadkly U I <br /> n Pool t Spa ❑am Mmoomm <br /> I]Dairy 5 /r 1 <br /> �X Land Use Application Sites <br /> septic Pumper Truck/ S Jr�I ry p� Hausxo <br /> Yard/Chemical Toilets t 1-t 1 ` t/\J I, " V c t <br /> Wastewater Treatment Plant /� ---rrr��� UPA <br /> I]Housing Abatement T C__, 1 r AST/HM/HW <br /> I]MoleUHotel ,5 I <br /> n Chicken Ranch/Dog Kennel CUPA <br /> Fl 6 <br /> Medical Waste Facility UST <br /> I]Tattoo/Body Piercing <br /> ❑aaup Wnan <br /> I]Waste Tire g <br /> complaint <br /> other(Please Specify): ❑Accoutnma <br /> to <br /> ""BOXED AREA-EHD USE ONLY- <br /> -3 7— — FN—''k'/ ;...z 'e =n pz ' ',prru of I ie l Ae FV or A rla--^ <br /> • <br /> ❑ Records provided by Staff-PPR Complete. staff Name: SID ae.ps <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />