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RECEIVED <br /> SAN$JOWN <br /> (G{�1�'!•/1��rR�A�rW��pEnvironmental Health Department <br /> —COUNTY— JUL 2 � 2 PUBLIC RECORDS RELEASE APPLICATION <br /> rrj0,( �LI <br /> PERM <br /> EHD LOG NUMBER: <br /> APPLICANT: Heather N.Conner BUSINESS/AGENCY:Fulcrum Resources <br /> ADDRESS: 119 Emily Drive CITY/STATE/ZIP:Salisbury,MD 21804 <br /> PHONE (1): 443-736-3407 PHONE(2):410-603-1133 FAX OR E-MAIL: heather@frenvim.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 DATE 07121/2018 <br /> 1. List up to ten addrefa— <br /> sses it 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 infoftsicehd.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. -,3� <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 1970 to 2018 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( ponly, 9 p <br /> FILES S ecific addresses address ranges will not be accepted) EHD USE ONLY <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) p u(V- t L]Cousumsa <br /> Q Other Cleanup Site(Non-LOP) 1 3820 West Lane Stockton <br /> • 0 Hazardous Waste Dam. <br /> Q Tiered Permitted Facility 2 <br /> 3826 West Lane Stockton _ N-F-K. <br /> Q Aboveground Tank <br /> Q UST (Monitoring/Removal) p 4A, ❑PWS <br /> ❑X Hazardous Materials 3 3808 West Lane Stockton <br /> ❑x Spill/Release Response <br /> ❑x Solid Waste Facility/Vehicle 4 ley-t Arae Q.A11TY <br /> 1413 Bourbon Street (UST) Stockton ���Iw, ( (,p <br /> ❑Food Facility 1236 IKA2 lukiliT • -t <br /> Pool/Spa �y�`(2pgt ire Mmonnom <br /> Dairy 5 4040 West Lane (UST) Stockton L`oi <br /> Land Use Application Sites <br /> Septic Pumper Truck/ ❑HoUSMG <br /> a <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant &KIIA <br /> Housing Abatement 7 AST/HMI HW <br /> ❑Motel/Hotel <br /> Chicken Ranch/Dog Kennel COPA <br /> e UST <br /> Medical Waste Facility <br /> ❑Tattoo/Body Piercing Sou.WAsrE <br /> Waste Tire a <br /> ❑X Complaint <br /> Other(Please Specify): ❑Acco.u.wc <br /> 10 <br /> *'*BOXED AREA-EHD USE ONLY*** <br /> • 1��1 '(rlet M .an 'r,�.z ci' � o c1/.k 6A` n <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />