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DocuSign Envelope ID:24012D69-9490-4FC2-A1 [DEZ8'VE ` <br /> SAKJOAQU nvironmental Health Department <br /> • <br /> —COUNTY— <br /> JUL I Q Z 2018 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ilwil KNIIII14aff, MAL 00C10 <br /> PFMMCTA <br /> EHD LOG NUMBER: <br /> APPLICANT: La Tasha Laster-Mullins BUSINESS/AGENCY: PMZ Real Estate <br /> ADDRESS: 3515 Deer Park Drive, suite A CITY/STATE/ZIP: Stockton/CA/95219 <br /> PHONE(1): (209)482-4257 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 ca 6'1ff1f16P6rrange an appointment date and time to review the requeste�� <br /> SIGNATURE OF APPLICAN DATE <br /> 1. List up to ten addresse r slow. 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)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 EHD staff at the expense of the applicant. �/l I <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 <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> FILES <br /> ®Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) 1201 5. Stockton Center 11 CONSUMER <br /> 1 <br /> • Other Cleanup Site(Non-LOP) street <br /> Hazardous Waste ❑DAIRY <br /> ❑Tiered Permitted Facility 2 <br /> ®Aboveground Tank <br /> UEl PwsST (Monitoring I Removal) QIIJ�TJ{" <br /> Hazardous Materials 9 <br /> Spill/Release Response <br /> WATER QUALITY <br /> ®Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> ® ITE MITIGATION <br /> Pool/Spa <br /> Dairy 5 <br /> Land Use Application Sites HOUSING <br /> Septic Pumper Truck/ 6 ❑ <br /> Yard I Chemical Toilets / <br /> ❑Wastewater Treatment Plant 0 CUPA <br /> ❑Housing Abatement T AST/HM I HW <br /> ❑MotellHotel r <br /> ❑Chicken Ranch I Dog Kennel [g CUPA <br /> g UST <br /> ❑Medical Waste Facility <br /> Tattoo/Body Piercing [B SOLID WASTE <br /> ❑Waste Tire 9 <br /> Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 4MG <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />