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RECEIVED <br /> r` <br /> SAN JOAQUIN y <br /> � `I+ �b` nvironmental Health Department <br /> ---COUNTY- - PUBLIC RECORDS RELEASE APPLICATION <br /> EWA0NWNRjA .1-WILL-T1-L <br /> Gresatntss qro>,s hcre PE Mi I AIL 15-15,or EHD LOG NUMBER: V T02. <br /> APPLICANT: Lyna Black BUS INESSIAGENCY:Jacobs <br /> ADDRESS: 2525 Air Park Drive CITY/STATEiZIP:Redding,CA 96001 <br /> PHONE(1): 530-229-3295 PHONE(2):530-680-5276 FAX OR E-MAIL: lyna black@jacobs.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac you gfranne an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT of wz71 DATE <br /> 1. List up to ten addresses In the pace below. Address ranges WILL NOT be accepted. Select the typ�(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 lnfo@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 END 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) <br /> Electronic information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From t<<er;sc }t cc° r ! to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FiLES (Specific addresses only.,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) '`�rjH �7z��CONSUMER <br /> Other Cleanup Site(Non-LOP) t �O1tY:�' rt' r _>- 'SCAuo a s r X015/ <br /> �Hazardous Waste <br /> Tiered Permitted Facility 2f,,I /� 1V (aD <br /> Aboveground Tank <br /> UST (Monitoring l Removal) <br /> r =; AAi ptAL4 PWS (� <br /> ®Hazardous Materials ` 3 t t �, J ` <br /> 2`i�-33 ,-.� 7 <br /> �} Spill/Release Response <br /> Solid Waste Facility!Veh �'4 <br /> � <br /> (]Food Facility /�T U <br /> (]Pool 1 Spa N1 jH yt ,Q�Q�S/ Q��YirF Mtt�tww A.) <br /> Dairy \t <br /> 1o2J O �T )MV <br /> Land Use Application Silas /.�? <br /> ❑Septic Pumper Truck/ 6 f ! { Housi c <br /> Yard/Chemical Toilets f ti C j(moi ( of—of l NI] ( <br /> Wastewater Treatment Plant y Nh 4iW t 14 ( l T ��CUPA <br /> Housing Abatement 7 -!„r--,��r TraL� r��vJ� \r_k�V l� Vl 1 AS71HM1HW <br /> Motel(Holei J N o ca <br /> (]Chicken Ranch/Dog Kenna] ®COPA <br /> ❑Medical Waste Facility E UST <br /> Tattooll3ody Piercing ij SCUD WASTE <br /> []Waste Tire e <br /> ❑Complaint <br /> Other(Please Specify) 11 AQaUNTINO <br /> to <br /> —BOXED AREA-EHD USE ONLY <br /> 8 i0 <br /> 0 Records provided by Staff-APR Complete. staff Name: EHD 4"S <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />