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RECEIVED <br />s A N ] O A Q U I N4 -u6 o 12o,8 Environmental Health Department <br />--- <br />COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br />1`? ' ? ii t n �, 5 $ t.� r to�?rt� lnlVrlN ..gs%tAL. vmm <br />PERMIT/,6E.Rk4jbWIT BY EMAILA( <br />"2/EHD LOG NUMBER:130(2&F7 <br />APPLICANT: Justin Bauer <br />BUSINESS/AGENCY: Trileaf Environmental <br />ADDRESS: 2121 West Chandler Boulevard, Suite 108 CITY/STATE/ZIP: Chandler, AZ 85224 <br />PHONE (1): 480-850-0575 PHONE (2): FAX OR E-MAIL: i bfter,wtrileaf.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 Justin Bauer DATE <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 ansicehd.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: OX List ❑X Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />C0 <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />only, address ranges will not <br />y 9 <br />be acce ted <br />accepted) <br />EHD USE ON Y <br />QX Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />0 Other Cleanup Site (Non -LOP) <br />' <br />1950 <br />West Fremont <br />Stockton <br />K1% <br />i ❑ CONSUMER <br />�m/ <br />0 Hazardous Waste <br />�js� <br />n ct� 0 5 DAIRY <br />-l1 �®� P ❑ <br />Q Tiered Permitted Facility <br />z <br />2010 <br />West Fremont <br />StocktonGo,���+ <br />❑K Aboveground Tank <br />I) <br />❑ PWS <br />FX UST (Monitoring / Removal <br />Q Hazardous Materials <br />3 <br />Q Spill / Release Response <br />4 <br />WATER QUALITY <br />Q Solid Waste Facility / Vehicle <br />Food Facility <br />ITE MITIGATION <br />Pool / Spa <br />Dairy <br />5 <br />Q Land Use Application Sites <br />6 <br />❑ HOUSING <br />F] Septic Pumper Truck / <br />Yard / Chemical Toilets <br />F] Wastewater Treatment Plant <br />NKUPA <br />F] Housing Abatement <br />7 <br />AST/HM / HW <br />F1 Motel/Hotel <br />IPA <br />❑ Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />Tattoo/Body Piercing <br />SOLID WASTE <br />Waste Tire <br />9 <br />Q Complaint <br />❑ ACCOUNTING <br />F] Other (Please Specify): <br />10 <br />***BOXED to USE ONLY <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />