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ti <br /> SAN J OA Q U I N Environmental Health Department <br /> COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> SUBMIT BY EMAIL EHD <br /> 907 7 <br /> EHD LOG NUMBER: "tl� <br /> APPLICANT: Erik Brown BUSINESS/AGENCY: Partner ESI <br /> ADDRESS: 520 Shelly Drive CITY/STATE/ZIP: Pleasant Hill,CA 94523 <br /> PHONE(1): 925-305-5337 PHONE(2): FAX OR E-MAIL: Erik@mnm-env.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 Erik Brown °M-�.ro�- •� 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 infoCgbsicehd.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://www.sjgov.org/departmentienvhealth/public-records <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ® Underground Tank Street# Street Name city <br /> (UST)Cleanup Site 14 AA' a 4 ('K'+;gy'l ❑CONSUMER <br /> LOP , 4011 East Morada Lane Stockton <br /> ®Other Cleanup Site <br /> Non-LOP ❑DAIRY <br /> ® Hazardous Waste , 4027 East Morada Lane Stockton <br /> ®Tiered Permitted Facility <br /> ©Aboveground Tank ❑PWS <br /> N UST (Monitoring/ , 4053 East Morada Lane Stockton <br /> Removal <br /> ®Hazardous Materials ❑WATER QUALITY <br /> ©Spill/Release 4 4103 East Morada Lane Stockton <br /> Response <br /> ❑Solid Waste Facility/ %I h' V r,.,y ❑SITE MITIGATION <br /> ❑ FoodcFacillty , 4219 East Morada Lane Stockton <br /> ❑ Pool/Spa ❑HOUSING <br /> ❑ Da;ry <br /> ❑ Lend Use Application 4255 East Morada Lane Stockton <br /> e <br /> Sites ❑CUPA <br /> ❑Septic Pumper Truck/ AST/H M/HW <br /> Yard/Chemical Toilets 4321 East Morada Lane Stockton <br /> ❑Wastewater Treatment <br /> Plant HM'. PA'S"'R"lou ❑CUPA <br /> ❑ Housing Abatement 4339 East Morada Lane Stockton: ek5-q1, ✓ UST <br /> ❑ Motel/Hotel <br /> ❑Chicken Ranch/Dost ❑SOLID WASTE <br /> Kennel 9 4361 East Morada Lane Stockton <br /> ❑ Medical Waste Facility <br /> ❑Tattoo/Body Piercing ❑ACCOUNTING <br /> ❑Waste Tire <br /> ❑Complaint ro t pyo <br /> ❑Other(Please Specify): G ,Vhf ey(9 `'?o (, k l 11 <br /> "'BOXED AREA-EHD USE ONLY"' <br /> :, - c;� .�'..,'!-i,h�`l�� �.,�'- cl4,4d ��z/.1� �'i `7� 9 r". h..•.,,/� l ,t 'S�_li ' <br /> ❑ Records provided by Staff-PPR Complete. Starr Name: EHD 4e-0s <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />