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KJAf LU EHD LOG NUMBER <br /> SAN a,IOAQUIN COUNTY <br /> MAY U 9 2017 ENVIRONMENTAL HEALTH DEPARTML 86113 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTALHEAfthone: (209)468-3420 Fax: (209)464-0138 Web:www.socehd.com Email: infoCcDsicehd.com <br /> PERMIT/SERVCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: HEATHER CROTTY BUSINESS/AGENCY: ESCREENLOGIC <br /> ADDRESS: 11249 GOLD COUNTRY BLVD,#165 CITY/STATE/ZIP:-GOLD RIVER, CA 95670 <br /> PHONE (1): 916-288-8177 PHONE (2): FAX OR E-MAIL: H.CROTTY(a CREENLOGIC.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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by Staff. Dom M DATE May 9,2017 <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 list <br /> 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 above, or email to info(a)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 above. <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 $139 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 to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only, address ranges will not be acce ted <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ❑CONSUMER <br /> ®OTHER CLEANUP SITE(NON-LOP) 3218 W GRANT LINE RD TRACY <br /> Z HAZARDOUS WASTE F� (\ ❑DAIRY <br /> ®TIERED PERMITTED FACI�Yc3250 W GRANT LINE RD TRACY ��j I� <br /> C) v <br /> ®ABOVEGROUND TANK J*, <br /> ®UST (MONITORING/REM(W PWS <br /> ®HAZARDOUS MATERIALS r s 3260 W GRANT LINE RD TRACY <br /> rrT�'" 1� <br /> ®SPILL/RELEASE RESPONSE <br /> ® ATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE � 4 `)/Vn `� <br /> ❑FOOD FACILITY I/ <br /> POOL/SPA Z SITE MITIGATION <br /> DAIRY 5 <br /> F1 LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ 6 t' >/ J U) n E]HOUSING <br /> YARD/CHEMICAL TOILETS 1A ) 11A <br /> WASTEWATER TREATMENT PLANTW ';2 ®CUPA <br /> ❑HOUSING ABATEMENT T r La .id{ <br /> F-1 MOTEL/HOTEL a - U <br /> CHICKEN RANCH/DOG KENNEL ®CUPA-UST <br /> 8 <br /> F�MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING ❑SOLID WASTE <br /> WASTE TIRE g <br /> ®COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br />