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RECEIVED <br /> SAN JOAQUIN Environmental Health Department <br /> --COUNTY— MAsIR 16 1018 PUBLIC RECORDS RELEASE APPLICATION <br /> ` Greatness greys here.ENVIRQ <br /> A <br /> P'EIIMfr r '�/'� ` EHD LOG NUMBER: <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY:Geographic ServicesInc(GSI) <br /> ADDRESS: PO Box 4517 CITY/STATE/ZIP:Ciws Heights,CA 85611 <br /> PHONE(1): (856)229-7018 PHONE(2): FAX OR E-MAIL: kirstinh@gstenvironmenlal.mm <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 Kirstin Hazeltine a°".'A;o°,t':wr m w" DATE 37152o18 <br /> 1. List un 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. .3/�L <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) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From 1940 to Present(2018) <br /> ENVIRONMENTAL FILE ADDRESS 'I %A,9,—(W <br /> HEALTH DEPARTMENT ( p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> RX Underground Tank(UST) Street q Street Name City ,, <br /> Cleanup Site(LOP) oesuven (�{� <br /> 1111 kt <br /> St <br /> i <br /> Navy Drive Stockton❑X Other Cleanup Site(Non-LOP O <br /> • 0 Hazardous Waste <br /> DAIRY <br /> )]X Tiered Permitted Facility 2 <br /> ❑X Aboveground Tank 5f"1 �1\A�1-� HW w <br /> FX UST (Monitoring/Removal) ❑PWS <br /> Q Hazardous Materials 3 <br /> Q Spill Release Response <br /> WATae ounun <br /> MX Solid Waste Facility/Vehicle 4 <br /> R Food Facility <br /> R Pool/SpaIra MITIGXcON <br /> ❑Dairy a <br /> ❑X Land Use Application Sites <br /> ❑Septic Pumper Truck/ ❑fi Houc. <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant (CUPA <br /> ❑Housing Abatement 7 ASTI HM/HW <br /> F1 Motel/Hotel <br /> RX Chicken Ranch/Dog Kennel oUPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing $OLIO wASTe <br /> ❑Waste Tire 9 <br /> Q Complaint <br /> Other(Please Specify): Accounrlae <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> 3-W 1�- LrrileApe, cowo"r-lexrete 9L .RR ;,, jl "bej of L4,�_-C,&L.92vA <br /> PrOVIAJ <br /> 0 Records provided by Staff-PPR Complete. staff Name: 8HD 4a.0s <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />