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RECEIVED <br /> SAN J OAQ U I N Environmental Health Department <br /> COUNTY— DEC 12 2011 PUBLIC RECORDS RELEASE APPLICATION <br /> orness maws he E:WRONMEKTALFWsLTH 13 X01 <br /> PEWIT/SE6t"ACES EHD LOG NUMBER: <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographiq Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITY/STAAIZIP: Citrus Heights CA 95611 <br /> PHONE (1): 916-385-0202 PHONE(2): FAX OR E-MAIL: kirstinh@gsienvironmental.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you toar�ge an appointment date and time to review the requested records. <br /> oa <br /> SIGNATURE OF APPLICANT r(/ DATE 12/11/17 <br /> 1. List up to ten addresses in the spacT 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(a�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. <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <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(UST) Street# Street Name city <br /> Cleanup Site(LOP) 724 E Grant Line Road Tracy v f ElCcNsums <br /> • Other Cleanup Site(Nan-LOP) <br /> VHazardous Waste / ❑DAlay <br /> Rf Tiered Permitted Facility 2 8715 Grant Line Road W Tracy <br /> rAboveground Tank <br /> LUST (Monitoring/Removal) El PWS <br /> 9 Hazardous Materials a 2401 N MacArthur Drive Tracy <br /> Spill/Release Response <br /> QUALItt <br /> Solid Waste Facility/Vehicle 4 f <br /> Food Facility GID M <br /> rte VMG ON <br /> Pool/Spa <br /> Dairy 5 <br /> E] Land Use Application Sites HouerG <br /> Septic Pumper Truck/ a 11 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement T AST I His I HW <br /> ❑Motel/Hotel <br /> E]Chicken Ranch I Dag Kennel LPA <br /> g DST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing oue W.E <br /> Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑Accourvrirvc <br /> 70 <br /> *"BOXED AREA-EHD USE ONLY*** <br /> • -(1-1 —�rtwt Q r,el. redo <br /> ❑ Records provided by Staff-PPR Complete, start Name: EHD4846 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />