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SAN_ JOAQUI� RECEIV99onmen .Health Department <br /> —COUNTY— of -1• 30 2W PUBLIC RECORDS RELEASE APPLICATION <br /> __ Greatness gro+ s l;ere. �,J7435 <br /> F�lilIRO.N h�TH EHD LOG NUMBER: Q <br /> APPLICANT: ANNE DUMA BUSINESS/AGENCY: PK DATA INC <br /> ADDRESS: 5975 SHILOH RD, STE 114 CITY/STATE2IP: ALPHARETTA <br /> PHONE(1): 770-931-9677 PHONE(2): 678-640-0129 FAX OR E-MAIL: COMMERCIALPOOLSaPKDATA.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 PROCESSED VIA EMAIL BY STAFF.DOM M DATE OCTOBER 30,2017 <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 <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 infoPsicehd.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❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> ❑ Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) ®CONSUME <br /> t 800 W EIGHT MILE RD STOCKTON r I p <br /> Other Cleanup Site(Non-LOP) <br /> Hazardous Waste �7 ;q _ EI DaRv <br /> Tiered Permitted Facility 2 900 W- LOWELL AVE TRACY <br /> Aboveground Tank <br /> ❑UST (Monitoring/Removal) MOUNTAIN ElPWS <br /> a 1090S CENTRAL PKWY <br /> Hazardous Materials HOUSE <br /> F1 Spill/Release Response <br /> ❑WATER DuALIrr <br /> ❑Solid Waste Facility/Vehicle 4 1405 STONEWOOD AVE MANTECA <br /> F] Food Facility <br /> Z Pool/Spa ❑SITE MITIGATIeN <br /> ❑ Dairy 6 1641 N RIPON RD RIPON <br /> ❑Land Use Application Sites <br /> HOY6ING <br /> Septic Pumper Truck/ e 2725 PAVILION PKWY TRACY <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant ❑CUPA <br /> ❑ Housing Abatement 7 4030E MORADA LN STOCKTON AST/HM/HW <br /> ❑ Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 8 UST <br /> TattoG/eody Piercing 0 Sella WASTE <br /> Waste Tire a <br /> Complaint <br /> ❑ Other(Please Specify): ❑AccOUNrING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*"* <br /> X10/30/2017-EMAILED APPLICANT TO CONFIRM RECEIPT OF PRRA. DOM M <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 />