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ECEIVED • <br /> SAN:IOAQUp <br /> � ���� Environmental Health Department <br /> COUJUL 2 NTY PUBLIC RECORDS RELEASE APPLICATION <br /> �;. Greatness grows tEW <br /> PER1A FTIS1ER EHD LOG NUMBER: �2q 2.30 <br /> APPLICANT: Ken Cook BUSINESS/AGENCY:SB Gas&Market <br /> ADDRESS: 515 W t 1th St CITY/STATE/ZIP:Tracy Ca 95376 <br /> PHONE(1): 209-607-0484 PHONE(2):209-834-8838 FAX OR E-MAIL: sbgasandmarket@yahoo.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 Ken Cook D'9"a'"s'y°eaI— °°" DATE 07/24/2018 <br /> Date ZO <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 info(cDsicehd.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:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑X Map—Description: Map of underground pipes <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific y 9 p ) EHD USE ONLY <br /> FILES addresses onlyaddress ran es will not be acce ted <br /> [X Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ❑CONSUMER <br /> Other Cleanup Site(Non-LOP) 1 515 W 11th St Tracy <br /> ❑Hazardous Waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> UST (Monitoring/Removal) ❑PWS <br /> Hazardous Materials 3 <br /> Spill/Release Response <br /> WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 ❑ <br /> Food Facility <br /> F]Pool/Spa ❑SITE MITIGATION <br /> Dairy 5 <br /> ❑Land Use Application Sites �'i I' <br /> ❑Septic Pumper Truck/ 5 U L62)e, ❑HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant ❑CUPA <br /> ❑Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing <br /> ❑SOLID WASTE <br /> Waste Tire 9 <br /> ❑Complaint <br /> ❑Other(Please Specify): ❑AccouNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY <br /> �edL <br /> PrRecords provided by Staff-PPR Complete. staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />