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RECEIVE <br /> Health De artment <br /> SAN�.lOAQUIN z . Pnvironmentalp <br /> - <br /> ---COUNTY-- Mstl" 1 201 <br /> , PUBL�C <br /> RECORDS RELEASE APPLICATION <br /> Gi0 ess ( ens herd-NVIRONME Mkkf"MALU `PERMIT/ <br /> EHD LOG NUMBER. <br /> APPLICANT: John Sellman BUSINESS/AGENCY:ATC Group Services,LLC <br /> ADDRESS: 1117 Lone Palm Avenue,Suite 201E CITY/STATE/ZIP:Modesto,CA 95351 <br /> PHONE(1): 209-579-2221 PHONE (2):209-872-5291 FAX OR E-MAIL: john.sellman@atcgs.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 /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. 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(d,)slcehd.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. <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 any to <br /> ENVIRONMENTAL FILE ADDRESS 4 UIT W• (0-4 <br /> HEALTH DEPARTMENT p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> X❑Underground Tank(UST) Street# Street Name City <br /> CDCleanup Site(LOP) ❑ oNsuMER <br /> XQOther Cleanup Site(Non-LOP) ' 2650 N. MacArthur Dr. Tracy vo <br /> Rx Hazardous Waste <br /> ❑DAIRY <br /> XQ Tiered Permitted Facility 2 <br /> Q Aboveground Tank tLN1 <br /> X❑UST (Monitoring/Removal) ❑Pws <br /> xD Hazardous Materials 3 <br /> Q Spill/Release Response <br /> Solid Waste Facility/Vehicle 4 WATER QUALITY <br /> Food Facility <br /> D Pool/Spa S_E MITIGATION <br /> ❑Dairy 5 <br /> Land Use Application Sites <br /> F]Septic Pumper Truck/ ❑6 HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant We,PA <br /> Housing Abatement T AST/HM/HW <br /> []Motel/Hotel <br /> Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 6 UST <br /> Tattoo/Body Piercing <br /> ❑SOLID WASTE <br /> ❑Waste Tire g <br /> F]Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> vr-M Itel APA. o� PR4A 4lam <br /> c� C —_ <br /> it <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />