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CEIV D"J <br /> SAN—COUNTY �j Environmental Health Department <br /> tR I —COUNTY 0 3 2018 kA PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness 9rottpAjfiijbNMENjAL I <br /> PERMR/S[RV1 BY EMAIL EHD LOG NUMBER: <br /> APPLICANT: Amy Cox BUSINESS/AGENCY:ERM <br /> ADDRESS: 114 Sansome Street,Suite 750 CITY/STATE/ZIP:San Francisco,CA 94104 <br /> PHONE(1): 509.68D-3269 PHONE(2): FAX OR E-MAIL: amy.coxrQenn.com r <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to a rang an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE 04/03/218 <br /> 1. List up to ten addresses in the space belhW. 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(cDsicehd.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. l/ <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 all information available to all information available <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY <br /> FILES addresses onlyaddress ran es will not be acce ted <br /> 0 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) V Coesuuse <br /> • nX Other Cleanup Site(Non-LOP) 1 4101 South Airport Way Stockton <br /> ❑X Hazardous Waste //^"{RJ�' pym. • <br /> Q Tiered Permitted Facility 2 _ <br /> XJ Aboveground Tank t <br /> UST (Monitoring/Removal) I I P <br /> WS <br /> X Hazardous Materials ] l•l t/ <br /> ❑X Spill/Release Response <br /> nraa Ouum <br /> nX Solid Waste Facility/Vehicle 4 + r <br /> Q Food Facility ` 10 <br /> Fvr <br /> Q Pool/Spa /,•-/�///,/�� /f�J //J� /� s[m Mine MON <br /> ❑X Dalry 5 <br /> ❑ <br /> X Land Use Application Sites <br /> Houswa <br /> ❑X Septic Pumper Track <br /> 6 <br /> Yard/Chemical Toilets <br /> Iqxj Wastewater Treatment Plant CUPA <br /> IJ Housing Abatement 7 AST/HM IHW <br /> ❑X Motel/Hotel <br /> ❑X Chicken Ranch/Dog Kennel IS(CUPA <br /> RX Medical Waste Facility a UST <br /> Q Tatloo/9ody Piercing Sa.m Wasr6 <br /> FX Waste Tire 9 <br /> EX Complaint <br /> ❑Other(Please Specify): ❑Acceu.nN <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> . H-3-t ' ffi--iM R ,mel f&'e'p ' ( A-40- 1LJ Atte . a • <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD4846 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />