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" WED. <br /> P4 • EHD LOG NUMBER <br /> ��1���"""�"""�i, SAN JOAQUIN COUNTY I �(/'�{(/��/ <br /> �IA� ZO1� / ENVIRONMENTAL HEALTH DEPARTMENT `1/ l — V <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elqVip <br /> �AL)p,,p Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> I'�JA1'fT1S`Ef�lLr.1E9 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services Inc <br /> ADDRESS: PO Box 4517 CITY/STATE/ZIP: Citrus Heights CA 95611 <br /> PHONE(1): (916)385-0202 PHONE(2): (856)229-7018 FAX OR E-MAIL: kirstinh@gsienvironmental.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 EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � jyp q��gpyQ, DATE 5199117 <br /> 1. List up to ten addresses in the space Belo . elect the types)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-5:0013M(EXCLUDING HOLIDAYS) I5\ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From 1940(or eadiestdevelopement) to Present <br /> ENVIRONMENTAL - -- <br /> HEALTH <br /> FILESRTMENT FILE ADDRESS EHD USE ONLY <br /> _ffUNDERGROUND TANK(USTI Street# Street Name City <br /> { CLEANUP SITE(LOP) 1 1111 Navy Drive Stockton T- Z � MER <br /> J OTHER CLEANUP SIM(NON-LOP) <br /> Kg HAZARDOUS WASTE <br /> DN <br /> VTIEREO PERMITTED FACILITY $ <br /> ABOVEGROUND TANK <br /> UST (MONITORING/REMOVAL) -- PWS <br /> HAZARDOUS MATERIALS 3 <br /> JaSPILL/RELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 WATER QUAL" <br /> [ZFGGD FACILITY <br /> ❑POOL/SPA SITE MmGanoN <br /> ❑DAIRY 6 <br /> 21L ND USE APPLICATION SITES <br /> &dSEP IC PUMPER TRUCK/ - ❑HOMING <br /> 6 <br /> YARD(CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMENT T UPA <br /> ❑MOTEL/HOTEL <br /> IIC.Iy CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY S <br /> ❑TATTOO/BODY PIERCING <br /> WASTE TIREEZ SOLID WAsrE <br /> 9 <br /> COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): <br /> A�UN NG <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— p <br /> c! A7- �C ro-c 3 9 a <br /> ; 6 to w L.--O i <br /> r 1 r64 4 11 i 03 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />