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From: Erik Brown Fax:(088)828-2635 c (209)464-0138 Page 2 of2 1ZU8/ZU1r1U.bZAM <br /> EnvirogirnentoFlealth Department <br /> f:`,: ., > GC>lJ Y - DEC Z S Zd1IcI PUBLIC RECORDS RELEASE APPLICATION <br /> -.w parr:. 1Z <br /> `= bMRQNMEWALH!MJH <br /> ``�„, PEIVAMERWM EHD LOG NUMBER: '077.34 <br /> APPLICANT: �/'}'(4:l ,(JUr V•°• BUSINESSIAGENCY: ,� Su i.•e.y1. <br /> ADDRESS: ' .p - I w ->CIT YfSTATEfLIP: <br /> aA1rr_ rIi rr p ,� <br /> PHONE(1): �jtff i 6 Z V Oil PHONE(2):[ FAX OR E-MAIL: �r r j� CaatE <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arranapan in t date and time to review the requested records. 1. <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List un to ten addresses in rise space[4rstavv$Addres rimes WILL NOT be accepted. Select the type(s)of files frorn th <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 infoOsiceholcom Applications received after 3:00'pm be processed the next <br /> business day. <br /> 2. For assistance In identifying the nature and content of EHD records, please contact EHD atthe 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 6:00 AM5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—.Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS U <br /> HEALTH DEPARTMENT 57 �15g�m �'y`ryl IJ` 7 <br /> FILES (Specific addresses only,address ranges will not be accepted) ��® 4�d E ti9 L.�� <br /> `underground Tank(UST) Street# Street Namo —� city <br /> t7.Cleanup Site(LOP) <br /> OM1 t4 5er Cleanup Site(Nan-LOP) (,. <br /> (rHazallous Waste <br /> oum <br /> aTeretl Pcrmittetl Facility 1 <br /> MAbovegmund Tank <br /> ,BUST (Monitoring/Removal) E PWS <br /> gHazardous Materials 5 <br /> Spill/Release Response <br /> Solid Waste Facility 1 Vehicle 4 <br /> area khwi.rtv <br /> Food Facility <br /> Pool/Spa -- <br /> ir MmonrroN <br /> L]Dalry s <br /> ❑Lend Use Application Slits <br /> ❑Septic Pumper Truck/ ❑HwsiNe <br /> 6 <br /> Yard I Chemical ToBets <br /> ❑Wastewater Treatment Plant <br /> CL1PA <br /> F]Housing Abatement r <br /> P.BT/HMIHW <br /> MolellHotel <br /> i <br /> ❑Chicken Ranch/Dog Kennel COPA <br /> Medical Waste Facility 6 UST <br /> Tattoo/Body Piercing <br /> ❑Waste Tire 6 ❑souo Wrsre <br /> ❑Camplalnt <br /> ❑Other(Please Specify): <br /> 'IU ❑Accouarwa <br /> —BOXED AREA-EHD USE ONLY° <br /> I z-W-1-7 -4 nM Ga. /w 2 A- of is w- +viz_ file . 6blA <br /> i_ < <br /> 1-i(o- 6 - r i <br /> E Records provided by Staff-PPR Complete. staff Name: EHoaa-gs <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> —Received Time Dec. 28, 2017 10:46AM No, 2195 <br />