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SAN 10AQUI V ECE'V vironmental Health Department <br /> C C I_I N I Y -- MAR 3 U 2018 PYBLIC RECORDS RELEASE APPLICATION <br /> EWRONMEMAL iiCfil FH -�'40 �3 Z6 <br /> tocaearrce«rr+�8 EHD LOG NUMBER' <br /> APPLICANT: Heather Crotty BUSINESSIAGENCY: eScreenLogic <br /> ADDRESS: 11249 Gold Country Blvd. CITY/STATEIZIP: Gold River,CA 95670 <br /> PHONE(1): 916-288-8174 PHONE(2): FAX ORE-MAIL: h.crottyCo)escreenlogic.00m <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arran a an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT—W on. �R&; DATE 3/30/18 <br /> 1. List up to ten addresses in the space below. Address rangILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least on file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below, or email to infoCdsicehd 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. /gyp <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) LA <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS tFi U C VN IFS <br /> HEALTH DEPARTMENT 9accepted) D S <br /> FILES (Specific addresses only,address ranges will not be <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) CmaUMER <br /> Other Cleanup Site(Non-LOP) t 1031 Wat 00 • D i(/Q d. Stockton NO (J / /y <br /> % <br /> Hazardous Waste <br /> r E]oaR+ <br /> Tared Permitted Facility x 1635 Roose)elt Stockton N 0 1 A)0 w 5 <br /> Aboveground Tank • (l 0- <br /> MUST (Monitoring/Removal) vY <br /> Hazardous Materials 1649 Roosevelt St. Stockton <br /> Spill/Release Response �� (�J'� <br /> ❑Solid Waste Facility/Vehicle q �St, Nw, tf7 t�/1' 2 CD <br /> ❑Food Facility 1100 N Wilson Way Stockton Q 0 Ta9l2 <br /> ❑Pool/Spa ih Mmcmox <br /> ❑Dairy a <br /> ❑Land Use Application Sites <br /> ❑Septic Pumper Truck/ 6 <br /> ❑HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUP, <br /> F] Housing Abatement 7 AST/HM/HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel COPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing <br /> Waste Tire a [jSouo Waste <br /> Complaint <br /> Other(Please Specify): ❑Accouxrwc <br /> tp <br /> • <br /> / ***BOXED AREA-EHD USE ONLY—*k-r,r.,Irte - M-✓Mw !/Y�c�'- - �,A'h2 (I <br /> 10 ✓ I I <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: ,. 8 e EHD 48-0s <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />