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RECEIVED <br /> SAN J O A Q U I N � � Environmental Health Department <br /> C O U N T Y "i� I i PBLIC RECORDS RELEASE APPLICATION <br /> EWRo-NMENTALHEN PErWjT18EF?,A'vES EHD LOG NUMBER: V 407 <br /> APPLICANT: Corinne Ackerman BUSINESSIAGENCY: Stantec Consulting Services <br /> ADDRESS: 3875 Atherton Road CITYISTATEIZIP: Rocklin, CA 95765 <br /> PHONE(1): 916 468-9568 PHONE(2): 916 472-3980 FAX OR E-MAIL: corinne.ackerman@stantec.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac-& an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT_ f % _� DATE 04/04/18 <br /> 1. List up to ten addresses in tiiu or,d,­�u, ivw. 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@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 fifes 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.E / <br /> Future file reviews by the same applicant may require a $152 deposit prior to review. f <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANI-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From .,..,, <br /> to <br /> ENVIRONMENTAL FILE ADDRESS '1 Ulf C �, <br /> HEALTH DEPARTMENT P y 9accepted) E�� U E ONLY <br /> FILES S ecific addresses only, address ranges will not be <br /> I)q Underground Tank(UST) Street# Street Name Clty <br /> Cleanup Site(LOP) 9_T, <br /> _T, D <br /> ®other Cleanup Site{Non LOP t 216 S.Sacramento Street Lodi / <br /> Biu 7 <br /> Hazardous waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> f>q UST (Monitoring!Removal) ❑PWS <br /> N Hazardous Materials 9 <br /> 71 Spill 1 Release Response <br /> C]Solid waste Facility 1 Vehicle a WATER QUALnr <br /> Food Facility <br /> Pocl!Spa SrrE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> F]Septic Pumper Truck 1 ❑s HOUSING <br /> Yard 1 Chemical Toilets <br /> Q wastewater Treatment Plant FC"—IPA <br /> ❑Housing Abatement 7 ASTIHMlHW <br /> ❑ Motel/Hotel <br /> Chicken Ranch 1 Dog Kennel KOU PA <br /> Medical waste Facility a UST <br /> []Tattoo/Body Piercing <br /> 9 [;Salo WASTE <br /> Waste Tire <br /> Complaint <br /> Other(Please Specify): []AcceuNTING <br /> �o <br /> —BOXED AREA-EHD USE ONLY— <br /> �-t-tl-4+�W�r-�,�t.1c��� +� rr. e.;;•t�-ir�e�. �cr� r-� � � 1 '��,d a:t � �, er �.�,�- �v��i ', r�„�n t��--- <br /> r ; <br /> Z- r j <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.coni <br />