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SAN.�JOAQUIN 2�d ,� Environmental Health Department <br /> C O U N T Y---- `�ZZ A PUBLIC RECORDS RELEASE APPLICATION <br /> ZAPSUBMIT BY EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: Megan Mauer BUSINESS/AGENCY:escreenLogic <br /> ADDRESS: 1221 S Congress Ave.,Apt,238 CITY/STATE/ZIP:Austin,TX 787804 <br /> PHONE(1): 5128787055 PHONE (2): FAX OR E-MAIL: <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 m.mauer@escreenlogic.com DATE 7/30/2018 <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(o@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 to <br /> ENVIRONMENTAL FILE ADDRESS f11p5 fv- QjzvAew 22 1, <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) Nu li <br /> / 1 CONSUMER <br /> 1 730 Channel St. Stockton <br /> Q Other Cleanup Site(Non-LOP) ���25 C000y I�� <br /> F1 Hazardous Waste E]n 1n D6 DAIRY <br /> Tiered Permitted Facility 2 145 Grant StN• kton N <br /> 1 <br /> Aboveground Tank 1V <br /> X]UST (Monitoring/Removal) V PWS <br /> 3 n <br /> X❑Hazardous Materials1%711 <br /> Fx Spill/Release Response <br /> ❑WATER QUALITY <br /> Solid Waste Facility/Vehicle q <br /> Food Facility <br /> El Pool/Spa ❑SITE MITIGATION <br /> F-]Dairy6 o n <br /> Land Use Application Sites <br /> HOUSING <br /> ❑Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant OtCUPA <br /> Housing Abatement 7 e r AST I HM/HW <br /> ❑Motel/Hotel <br /> E]Chicken Ranch/Dog Kennel ❑CUPA <br /> 8t' n n UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> —BOXED <br /> `AREA-EHD USE OI NLY— <br /> 22 1 g— <br /> C Cu <br /> ❑ Records provided by Staff- PR Complete. staff Name: EHD 48-0 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />