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I 6 <br /> I <br /> SAN JO11OUIN � i ` a t <br /> -- - C O l .) ;�I T Y - - - PUBLIC RECORDS RELEASE APPLICATION <br /> 11f � ) �': ". � . y. <br /> SUBMIT BYM <br /> EHD LOG NUMBER . <br /> APPLICANT : Suzanne Nase BUSINESS/AGENCY : Geocon p <br /> ADDRESS : 6671 Brisa St CITY/STATE/ZIP : Livermore , Ca 94550 <br /> PHONE ( 1 ) : 925-371 -5900 ext . 414 PHONE ( 2 ) : 925-701 - 1040 _ FAX OR E - MAIL : nase@geoconinc. com <br /> Please allow 10 busines ays from date of application submittal for the records to be available. ) <br /> Staff will contact you rr nge an appoltltment date and time to review the requested records . <br /> SIGNATURE OF APPLICANT - DATE 3/26 119 <br /> 1 . List up to ten addresses in the space below. Address ranges OT 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 infoAslcehd . 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 /> SEPTIC AND WELL PERMITS ARE AVAILABLE FOR REVIEW ONLINE AT: https :llwww. sjgov. org/department/envhealth/public •records <br /> Electronic information : ❑ List ❑ Map — Description : <br /> Specific Date Range of Information Requested : From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only , address ranges will not be accepted ) EHD USE ONLY <br /> ® Underground Tank _ Street 9 Street Name city S <br /> ( UST) Cleanup Site ❑ CONSUMER <br /> LOP 521 Cherokee Ln Lodi <br /> * Other Cleanup Site Li <br /> Non-LOP ❑ DAIRY <br /> ® Hazardous Waste 2 930 Victor Rd Lodi <br /> ® Tiered Permitted Facility t <br /> Z Aboveground Tank ❑ PWS <br /> MUST (Monitoring / 3 450 Cherokee Ln Lodi <br /> Removal <br /> ® Hazardous Materials ❑ WATER QUALITY <br /> ® Spill / Release 4 681 Lockeford St Lodi <br /> Response <br /> ® Solid Waste Facility / ❑ SITE MITIGATION <br /> Vehicle <br /> ❑ Food Facili5 687 Lockeford St Lodi <br /> ty <br /> ❑ Pool / Spa <br /> ❑ DaJM <br /> ❑ HOUSING <br /> * Land Use Application 6 930 Victor Rd Lodi <br /> Sites <br /> ❑ Septic Pumper Truck / ❑ CUPA <br /> Yard / Chemical Toilets ' 880 Victor Rd Lodi AST / HM / HW <br /> ❑ Wastewater Treatment <br /> Plant ❑ CUPA <br /> ❑ Housing Abatement o 900 Victor Rd Lodi UST <br /> ❑ Motel/Hotel <br /> ❑ Chicken Ranch /"o ❑ SOLID WASTE <br /> Kennel s 940 Victor Rd Lodi <br /> ❑ Medical Waste Facillty <br /> ❑ Tattoo/Body Piercing ❑ ACCOUNTING <br /> ❑ Waste Tire <br /> ❑ Complaint io <br /> ❑ Other ( Please Specify) : <br /> ** *BOXED AREA EHD USE ONLY*** <br /> - G 3V0 L _ <br /> ❑ Records provided by Staff- PPR Complete . stall ame : EHD 48-06 <br /> i <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 -3420 F 209 464 - 0138 I www. sicehd . com <br />