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RECEIVED <br /> SAN >'J OA Q U I N MAY 3 0 4"Ainvironmental Health Department <br /> - C O U N T Y --- fi PUBLIC RECORDS RELEASE APPLICATION <br /> • Greotnes6 hews hcrc E /1 M g ONNENTAL t, -�L1 <br /> AIL (SIC0o2 <br /> EHD LOG NUMBER: <br /> APPLICANT: Lyna Black BUSINESSIAGENCY:Jacobs <br /> ADDRESS: 2525 Air Park Drive CITYISTATEIZIP:Redding,CA 96001 <br /> PHONE(1): 530-229-3295 PHONE(2):530-6130-5276 FAX OR E-MAIL: Iyna black@iacobs.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac you to r e an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT2ur�_ _ DATE <br /> 1. List un to ten addresses in the pace below. Address ranges WILL NOT be accepted. Select the Tyt�of files from the <br /> list below by checking the appropriate box(es). At least one fife type MUST be selected. Fax to(2091464-0138, mall to the <br /> address Indicated below,or email to Info(&sfcehd.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 hold for a maximum of Ove business days for review. Appointments <br /> should be scheduled accordingly. . <br /> 4. Any Ole not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. .� <br /> Future Ole 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 _r� ;�,T, to 1 rt-5`4 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y 9 P <br /> FILES (Specific addresses only, ranges will not be accepted) EHD USE ONLY <br /> .R]Underground Tank JUST) street M street Name city <br /> Cleanup Site(LOP) h!-.ota'i a Coesuuen <br /> 12 Other Cleanup Site(Non-LOP) t tD1a'� 'v.� („1r17r !1 c- ,,t `���-�•� <br /> PHazmdom Wasle LM i [I DAR, <br /> ❑Tiered Permitted Facility 2 q1' rre�s,s ( Aix{ or <br /> -�-�- <br /> AbovegroundTank 29�IZ5 •'_I'�r-r( <br /> )1 <br /> g_5L,UST (Mondodng I FerriS,h » ❑PWS <br /> Hazardous Melodals a t t �T C <br /> E;Spnl/Release Response 216 3 Tic i✓ / I S <br /> ITY/ <br /> Solid Waste Facility/Vehicle s p` s�re/a .Wry <br /> �Ou <br /> Food Facility l W' il <br /> Ej Pool/spa ®'SIM MITIGATION <br /> a -I <br /> Dairy _ � • ll <br /> ❑Land Use npplicavon Sites C> >T <br /> Sepik Pumper Truck/ 7 1\s•ktAe/ 0 Hoes� <br /> Yard I Chemical Toilets 4 2&,I S• Tri nbl.L)G� 11 <br /> Wastewater Treatment Plenl EIC1PA <br /> Housing Abatement T _TAa Llj 130tv I, �,.0`J\` �,�'�'• ASTIHM/HW <br /> Mole VHolol <br /> ❑Chicken Ranch/Dog Kennel (RCUPA <br /> T <br /> Medical Waste Facility UST <br /> Taeaalaody Plorcing 0 SouD WASTE <br /> [Waste Tu e <br /> Complaint <br /> Other(Please Specify) 0 A¢oumma <br /> sa <br /> --BOXED AREA-EHD USE ONLY— <br /> 0 Records provided by Staff-PPR Complete. Sian Name: EHD 4846 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />