Laserfiche WebLink
SANsd0A0UIN �� <br /> Environmental Health Department <br /> C O U N I Y ��ti PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness grows herr:. <br /> SUBMIT BY EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: Megan Mauer BUSINESS/AGENCY:escreenLogic <br /> ADDRESS: 1221 S Congress Ave.,Apt,238 CITY/STATE/ZIP:Austin,TX 787804 <br /> PHONE(1): 512878705-5 PHONE(2): 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 /> 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(cDslcehd.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) 8)3 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS �- U HJT <br /> HEALTH DEPARTMENT ( p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Q Underground Tank(UST) Street# Street Name City1 - n <br /> Cleanup Site(LOP) U 9 r� 0 F]CONSUM=_a <br /> �X Other Cleanup Site(Non-LOP) 730 Channel St. Stockton / <br /> FX_j Waste <br /> F-1Tiered Permitted Facility 2 145 Grant St. Stockton U5T_ ❑DAIRY <br /> F­l Aboveground Tank ((( <br /> Q UST (Monitoring I Removal) I-]PWS <br /> 3 <br /> Q n Hazardous Materials , <br /> FX Spill/Release Response <br /> F1 Solid Waste Facility/Vehicle 4 Lef QC <br /> E]WATER QUALITY <br /> Food Facility <br /> Pool 1 Spa ❑SITE MITIGATION <br /> Dairy 5 o n <br /> ❑ Land Use Application Sites <br /> Septic Pumper Truck/ ❑HOUSING <br /> Yard!Chemical Toilets n <br /> Wastewater Treatment Plant ❑CUPA <br /> F] Housing Abatement 7 TMMjr AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch I Dog Kennel CUPA <br /> UST <br /> Medical Waste Facility <br /> F]Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire 9 <br /> Complaint <br /> F]Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED>AREA-EHD USE ONLY*** <br /> /> Ch /I <br /> u <br /> DRi n�zcvri�a- 1'1a Staff-PPR C 9taff�G'aIT2:- EHD 48-06 <br /> g G o a �S5 "- "?( � ( 44 d` 1 <br /> 1868 E. Hazelton Avenue Stockton, ali ornl 9 w) I 2 34 0 F 2 9 64- 13 www. fce com <br /> CO. <br />