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RECEIVED <br /> SAN ) O A Q U I Nuft 17 2018 Environmental Health Department <br /> • EhMRONMEN;fAL F PUBLIC RECORDS RELEASE APPLICATION <br /> F PkMlT/` rtWMIT BY EMAIL v <br /> EHD LOG NUMBER: <br /> APPLICANT: Justin Bauer BUS]NESSIAGENCY:Trileaf Environmental <br /> ADDRESS: 2121 West Chandler Boulevard#108 CITY/STATE/ZIP:Chandler,AZ 85224 <br /> PHONE(1): 480-850-0575 PHONE(2): FAX OR E-MAIL: i.bauer@tnleal.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you pt a�rrange appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT nC�t.&L 1 DATE .5ar`t Z T, Zo I $r <br /> 1. List up to ten addresses in the pace below. Addirliss,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(2091464-0138,mail to the <br /> address indicated below,or email to infoldsicehd.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. /GI <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map— Description: _ <br /> Specific Date Range of Information Requested: From to _ <br /> P Y. 9 accepted) <br /> FILES FILE ADDRESS <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT EHD USE ONLY <br /> (Specific addresses only,address ranges well not be acce ted <br /> ❑X Underground Tank(UST) Street# Street Name City j <br /> cleanup Sita(LOP)• r fi Coseumaa FX Other Cleanup 1 707 Yosemite Ave. Manteca <br /> (]X Hazardous Waste p Duav <br /> �X Tiered Permitted Facility 2 <br /> QX Aboveground Tank NM H1A/ L-kn SM LOP t <br /> ❑x UST (Monitoring/Removal) ❑Ovvs <br /> Hazardous Materials a <br /> Qa SRelease Response la'll� I G� <br /> IJ Solidolid Waste Facility/Vehicle 4 mn Qvuirr <br /> F1 Food Facility <br /> FlPool/Spa ire MITIGATION <br /> Dairy 5 <br /> E]Land Use Application Sites <br /> ❑Septic Pumper Track/ ❑6 HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant DPA <br /> HOusing Abatement 7 ASTI HM I HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel COPA <br /> ❑Medical Waste Facility a UST <br /> E]Tattoo/Body Piercing ouo wAme <br /> ❑x Waste Tire g <br /> Q Complaint <br /> Other(Please Specify): ACCOUNTING <br /> 10 <br /> "BOXED AREA-EHD USE ONLY*** pp � <br /> ❑ Records provided by Staff-PPR Complete. Stan Name: EHD 4e.o6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />