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RECEIVED R&J 5-u rl' <br /> SAN N J OAQ U I N Environmental Health Department COUNTY )' 'I� 9-;� PUBLIC RECORDS RELEASE APPLICATION <br /> 1�1�1 '� I -EMAIL <br /> pE{QMIff/5 EHD LOG NUMBER. `16 7 <br /> APPLICANT: Megan Mauer BUSINESS/AGENCY:eScreenLogic <br /> ADDRESS: 1221 S Congress Ave.Apt.238 CITY/STATE/ZIP:Austin,Tx 78704 <br /> PHONE(1): 5128787055 PHONE (2): FAX OR E-MAIL: m.mauer@escreenlogic.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 m.mauer@escreenlogic.com DATE <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 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 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. L, <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. J (� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: Zx List Zx Map—Description: -' 7' t <br /> Specific Date Range of Information Requested: From to �p uCl/hf <br /> ENVIRONMENTAL FILE ADDRESS '�- co (v-1q 1 <br /> HEALTH DEPARTMENT ( ponly, 9 p ) H D USE O N LY <br /> FILES S ecific addresses address ranges will not be accepted) "tea <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) , ❑CONSUMER <br /> Q Other Cleanup Site(Non-LOP) 1 �a�reed#e;. hore�&. <br /> FX Hazardous Waste t ,t-kyti , <br /> C ❑DAIRY <br /> Q Tiered Permitted Facilit � 2 8751 Hwy 12 Vi,(Y�'�t0 r tt�,� HNI <br /> Q Aboveground Tank ` t,�"[ U� P Ld 5 <br /> FX UST (Monitoring/Removal) <br /> Q�u I-k�i%LjLtA.(� ❑PWS <br /> Q Hazardous Materials _16 3 1 lj O r <br /> Q Spill/Release Response tkL <br /> Solid Waste Facility/Vehicle 4 Q Q m ATER QUALIT <br /> Food Facility (SCJ <br /> 8�& E Hwy 14 Victor <br /> ❑Pool I Spa N#§TE MITIGATION <br /> ❑Dairy 5 8 <br /> ❑Land Use Application Sites <br /> I-k.-i HOUSING <br /> Septic Pumper Truck/ 6 p4 9=11 <br /> Yard/Chemical Toilets O <br /> Wastewater Treatment Plant CUPA <br /> F­I Housing Abatement 7 4142 AST/HM/HW <br /> Motel/Hotel <br /> ❑Chicken Ranch I Dog Kennely CUUST IC <br /> Medical Waste Facility a W <br /> ❑Tattoo/Body Piercing <br /> X171. ❑Souo WASTE <br /> ❑Waste Tire �A y <br /> Complaint ��/ <br /> Other(Please Specify): I-A ❑ACCOUNTING <br /> 17285 rue a <br /> _Rd-5T7� <br /> ***BOXED AREA-EHD USE ONLY <br /> l: CD4VreA ,(tits:: .Y� PRU ', lA -L,-- kAz— t� "s 0 � <br /> �) � vi <br /> o- <br /> V r eHDII-N <br /> 8751 IZ . <br /> 1868 E. Hazelton Avenue I Stockto Califorpia 5205 1 T 209 468-3420 1 F 209 464-g1l38 www.s ce .co <br /> hd <br /> E �nG( � �v1 <br /> ��; 0Go �aC,J1 tAj1G{,+1,t�f1�s ';�1 �� r- <br />