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RECEIVED <br /> SAN J O A Q U I N �� 12 201? Environmental Health Department <br /> -- <br /> - COUNTY --- PUBLIC RECORDS RELEASE APPLICATION <br /> • Grecrney< ,_;.crr; hFh�NIIIRt.1NME:�_ALI'I��S-Fit 7� <br /> �PWr'fSE9,A 'E5 EHD LOG NUMBER: <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographip Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITYISTA-rF/ZIP: Citrus Heights CA 95611 <br /> PHONE(1): 916-385-0202 PHONE(2): FAX OR E-MAIL: kirstinhogsienvironmental.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to age an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT dC DATE 12/11/17 <br /> 1. List up to ten addresses in the spacdF 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(aosicehd.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. l <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS)IhJ <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y g accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) -1 OP ❑DONauM <br /> Rf Other Cleanup Site(Non-LOP) ' 724 E Grant Line Road Tracy <br /> • EZ Hazardous Waste El DAlW <br /> Tiered Permitted Facility 28715 Grant Line Road W Tracy <br /> [Aboveground Tank <br /> SdUST (Monitoring/Removal) ❑PWS <br /> Rf Hazardous Materials $ 2401 N MacArthur Drive Tracy <br /> [Spill/Release Response <br /> �I2U 11 <br /> Solid F a ATaa OUAcm <br /> Waste Facility/Vehicle y I / n inn <br /> Food Facility ( vV (1 I r, <br /> Pool/spa KITE MITGAnOo <br /> ❑Dairy 6 <br /> ❑Land Use Application Sites <br /> ❑Houswc <br /> Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant COPA <br /> F1 Housing Abatement 7 AST IHIM/HW <br /> Matel/Hotel <br /> Chicken Ranch/Dog Kennel UPA <br /> 8 UST <br /> ❑Medical Waste Facility <br /> ❑Tattoo/Body Piercing ouo WAsre <br /> ❑Waste Tire g <br /> EzComplalnt <br /> Other(Please Specity): ❑Aewuenno <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> • - ^1 <br /> ke4l 6hek feCe n n ;ne z Na l i e M <br /> A <br /> ❑ Records provided by Staff-PPR Complete. staff Name: BHo is <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />