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RENS® SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> k, ENVIRONMENTAL HEALTH DEPARTMENT /� <br /> APR 1 1 2017 1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 y�� u <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.com Email: inforaosicehd com �/ —` <br /> ENVIRONMENTAL ENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ��Rkll-Fl2r^'---- <br /> KPLICANT: Colton Toste BUSINESS/AGENCY: NAI Benchmark 151 Commercial <br /> DRESS: 2920 Pacific Ave CITY/STATE/ZIP: Stockton, CA 95204 <br /> PHONE(1): 209-461-6400 PHONE (2): 209-752-0296 FAX OR E-MAIL: <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. Dom M DATE_April 11 2017 <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 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(dsicehd 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. <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. /�/� <br /> _I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name city <br /> CLEANUP SITE(LOP) <br /> 221 ❑CONSUMER <br /> OTHER CLEANUP SITE(NON-Low N Wilson Way Stockton ,,,,I _ /^,n <br /> ®HAZARDOUS WASTE aJUvn Tlyft - 11VV/ OWXA I,+l/ <br /> DAIRY <br /> ®TIERED PERMITTED FACILITY 2 1426 E Miner Ave Stockton p <br /> ®ABOVEGROUND TANK 1v <br /> ®UST (MONITORING/REMOVAL) <br /> PWS <br /> ®HAZARDOUS MATERIALS B <br /> ®SPILLIREI-7SE RESPONSE <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 _ ®WATER QUALITY <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA <br /> ❑ MI <br /> ®sl <br /> DaaY 6 ` Sim MITIGATION <br /> ®LAND USE APPLICATION STIES <br /> ❑SEPTIC PUMPER TRUCK/ B HOUSING <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT <br /> ® <br /> ❑HOUSING ABATEMENT 7 - CUPA <br /> ❑MOTELIHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL ID CUPA-UST <br /> 8 <br /> ❑MEDICAL WASTE FACILITY <br /> ❑TATTOO/BODY PIERCING <br /> ❑WASTE TIRE B ❑SOLID WASTE <br /> ®COMPLAINT <br /> F1OTHER(PLEASE SPECIFY): <br /> TBF E3 ACCOUNTING <br /> ""BOXED AREA EHD USE ONLY- <br /> 0000.31`I3� 1 <br /> tO R❑ Records provided by Staff-PPR Complete. staff Name: <br />