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SANsJOAQUIN Environmental Health Department <br /> -COUNTY— �Z${� PUBLIC RECORDS RELEASE APPLICATION <br /> �. <br /> Greatness Gro; s herc. <br /> - SUBMIT BY EMAIL <br /> EHD LOG NUIVIBER??%�_ <br /> APPLICANT: John Lane BUSINESS/AGENCY:Condor Earth <br /> ADDRESS: 188 Frank West Circle,Suite I CITY/STATE/ZIP:Stockton,CA 95206 <br /> PHONE(1): 209-988-1061 PHONE (2):209-743-7443 FAX OR E-MAIL: ilane@condorearth.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 08/2V18 <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(o)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. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS)C �] <br /> Electronic Information: ❑x List❑ Map–Description: us- UST Ee-, =i S-ve-Septic,Well.Drdli^q Pe-Tiof <br /> Specific Date Range of Information Requested: From 1=F to 2010 <br /> ENVIRONMENTAL FILE ADDRESS �--J 1 Co. 313d- <br /> HEALTH DEPARTMENT ponly, g p <br /> FILES S ecific addresses address ranges will not be accepted) EHD USE ONLY <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) u�� CONSUMER <br /> ❑ 23569S. Santa Fe Road Riverbank/Escalon (�� <br /> 1 <br /> X Other Cleanup Site(Non-LOP) 60 <br /> ❑Hazardous Waste No U 9 DAIRY <br /> ❑Tiered Permitted Facility z 23565 S. Santa Fe Roa Riverbank/Escalon A' <br /> ❑Aboveground Tank /V (.�l /, <br /> ❑X UST (Monitoring/Removal) NO ❑PWS <br /> ❑Hazardous Materials 3 23659 S. Santa Fe Road Riverbank/Escalon <br /> 0 Spill/Release Response No uq <br /> 0 Solid Waste Facility/Vehicl 4 W U,5� ❑ ATER QUALITY <br /> 23665 S. Santa Fe Roa Riverbank/ a 1 <br /> Q Food Facility /1!D <br /> A'^ Q SITE MITIGATION <br /> ❑Dairy Spa 5 23659 Henry RoadIRiverbank/Escalon <br /> erbank/Es alon <br /> ❑X Land Use Application Sites 7 i <br /> F1 Septic Pumper Truck/ 6N 0 11 HOUSING <br /> 23665 Henry Road <br /> Yard/Chemical Toilets NO <br /> ❑Wastewater Treatment Plant ❑CUPA <br /> ❑Housing Abatement 7 AST/HM/HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel RICUPA <br /> ❑Medical Waste Facility s UST <br /> ❑Tattoo/Body Piercing it SOLID WASTE <br /> ❑Waste Tire 9 <br /> ❑Complaint <br /> X❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> UST, LOP, UST Removal, Se er/Septi , Well, Drilling Permit Applica ions <br /> ***BOXED AREA-EHD USE ONLY*** <br /> t ` s <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />