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RECEIVED <br /> SAN J O A Q U I N � � 12 X017 Environmental Health Department <br /> COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> _ciness grcivs heElmlioNmEEXTALF ALTH7�1 <br /> • PEINMITISERM ICES EHD LOG NUMBER: <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: GeographiQ Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITY/STA*1ZIP: 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 to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE DATE 12/11/17 <br /> 1. List up to ten addresses in the spat below. Address ranges WILL NOT be accepted. Select the types)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 infoCdsicehd 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 /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS)`J•�ovJ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y g p ) EHD USE ONLY <br /> FILES addresses onlyadtlress ran es will not be acce ted <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup She(LOP) CONSUMER <br /> Other Cleanup Site(Non-LOP) 1 724 E Grant Line Road Tracy <br /> • V Hazardous Waste x p Dam <br /> Tiered Permitted Facility 2 8715 Grant Line Road W Tracy <br /> Aboveground Tank <br /> N UST (Monitoring/Removal) ❑PWS <br /> 9 Hazardous Materiels a 2401 N MacArthur Drive Tracy <br /> ySpill I Release Response <br /> Solid Waste Facility/Vehicle 4 iry,ATE6 Cuaury <br /> ❑Food Facility <br /> Pool/Spa VI MITIGATION <br /> Dairy 6 <br /> ❑Land Use Application Sites <br /> Septic Pumper Truck/ ❑Houswc <br /> 6 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUPA <br /> Housing Abatement T AST/HM IHW <br /> Motel/Hotel <br /> Chicken Ranch I Dog Kennel Nr6UPA <br /> Medical Waste Facilky 6 UST <br /> Tattoo/Body Piercingouo WASTE <br /> Waste Tire 9 <br /> Complaint <br /> Other(Please Specify): ❑Accouwnnc <br /> 10 <br /> *'*BOXED AREA-EHD USE ONLY*** <br /> JA <br /> • – Z^� —�hte:1 hey fNCe'p 3 �Yn, n ,ne P4 eta 6a die M <br /> ❑ Records provided by Staff-PPR Complete. staff Name: END U46 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />