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A`� VJ! M Pt1'1' TO: IZO946401:38 VRUM :U16;3'1t 0704 Page: 2 <br /> 9—to SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> AUG 2 2 2011 6�AP— 3Pr-, ENVIRONMENTAL HEALTH DEPARTMENT <br /> *� &D REQUEST** 1868 East Hazelton Avenue,Stockton, CA 95205-6232 �� <br /> E� �J7q HEALTH Telephone: (209)468-3420 Fax: (205)464-0138 Web:www.sjgov.arg/ehd <br /> PERMITiSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> PPLICANT: Heather Crotty BUSINESS/AGENCY: eScreenLogic <br /> ADDRESS: 1124*9 Gold Country Blvd. CITYISTATEIZIP: Gold River, CA 95670 <br /> PHONE(1): 916-288-8174 PHONE(2): FAX OR E-MAIL: h.crotty@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 /> ❑ CHECK BOX TO EXPEDITER QUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �C( 6_41 C4_161DATE 8/22/17 <br /> 1. List up to ten addresses in the space below. Sele the type(s) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next 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 /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> Electronic information: 0 List ❑ Map-- Description: <br /> Specific Date Range of Information Requested: From /to� [, f I <br /> ENVIRONMENTAL — (0 L)e, 1 � ° f �`"v��r -7 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) 1220 E Pine St `1 <br /> .-UST 1 4G,,T` � I�j I LI"su.ILrt <br /> OTHER CLEANUP SITE(NON-LOP) 11-1 Lodi _ 4)0'�-tt� ¢7� <br /> HAZARDOUS WASTE <br /> r. I� <br /> 1/\F0 DAIRY <br /> ❑TIERED PERM;TTED FACILrrY 2/ NO <br /> ❑ABOVEGROUND TANK 1204 E Pine St. Lodi !v3 r1w <br /> ❑UST (MONTfORING!REMOVAL) f A© ❑ 'S <br /> HAZARDOUS MATERIALS 3 • `� <br /> 1206 E Pine St. Lodi <br /> ®SPIWRELEASE RESPONSE <br /> F-1SOLOWASTE FACILFrY 1 VEHICLE µ I' b' WAFER QUALLIY <br /> ❑FOOD FACILITY 1240 E Pine_ St.-UST Lodi <br /> POOL/SPA J. <br /> fd! / SR:WkTIGgi70tiDAIRY 0Ffl+n❑LANO Use APPUOATION sires 12 S Cluff Ave,-HM&HW LrV CI <br /> SEPTIC Pumr'ER TRUCK! ,)Z9 ❑HousING <br /> F-1s E Pine 5t. -looking for Historic U�- <br /> YARD r CHEMICAL Tozmrs 1126 UST removal elate Lodi J',) �.(l!�t <br /> F-1WASTEWAYER TREATMENT PLANT -. <br /> F-1 HOUSING AOATEMENT 7 N Ciuff Ave.-Leaking r�(l.� �/��- � UPA <br /> Underground `"����� lyt�/yAV <br /> E]M©TEUHOTEL 42 Storage Tank Documents Lodi rLs� uV <br /> ❑CHIcKEN RANCH I DOG,KENNEL NkUPA-UST <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOOIBODY PIERCING <br /> ❑WASTE TIRE ❑SOLID WASTE <br /> s <br /> ❑COMPLAINT <br /> ©OTHER(PLEASE SPECIFY)', ❑Aaroumm�^ <br /> 10 <br /> I - <br /> `..BOXED AREA-EHD USE ONLY— <br /> . uA eqn, 7 fay , <br /> t ut lrl (n 77 <br /> ❑ Records provided by Staff-PPR Complete. start Name: GVFW <br /> �y l _ <br /> Received Tirf)e`Aug. 22. 2017= 3 : 54PNFNo. 2148 <br />