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SAN JUAQUIN ,',a,,I� <br />J I- ------ COUNTY------ j tiZ Ate <br />Greatness grows here_ <br />APPLICANT: Erik Brown <br />ADDRESS: 520 SHELLY Drive <br />Environmental Health Department <br />PUBLIC RECORDS RELEASE APPLICATION <br />SUBMIT BY EMAIL q <br />EHD LOG NUMBER: t �.! <br />BUSINESS/AGENCY: Partner ESI <br />CITY/STATE/ZIP: Pleasant Hill, CA 94523 <br />PHONE (1): 925-262-8101 PHONE (2): 925-305-5337 FAX OR E-MAIL: Erik@mnm-env.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 Erik Brown DATE 8/10/18 <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(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 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. ii <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS)203� <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to If <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />only, address ranges will not <br />be accepted) <br />EHD USE O Y <br />xj Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />' <br />^ <br />2 <br />W. Yettner Road <br />French Camp <br />❑ CONSUMER <br />Cleanup Site (LOP)^ <br />QX Other Cleanup Site (Non -LOP) <br />LJ <br />0 Hazardous Waste <br />❑ DAIRY <br />I] Tiered Permitted Facility <br />2 <br />Q Aboveground Tank <br />❑ PWS <br />Q UST (Monitoring / Removal) <br />0 Hazardous Materials <br />3 <br />Q Spill / Release Response <br />4 <br />❑ WATER QUALITY <br />Solid Waste Facility / Vehicle <br />Food Facility <br />❑ SITE MITIGATION <br />Pool / Spa <br />Dairy <br />5 <br />F] Land Use Application Sites <br />❑ HOUSING <br />F] Septic Pumper Truck / <br />6 <br />Yard / Chemical Toilets <br />171 Wastewater Treatment Plant <br />gCUPA <br />❑ Housing Abatement <br />7 <br />AST/HM IHW <br />Ll Motel/Hotel <br />❑ CUPA <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 />Complaint <br />❑ ACCOUNTING <br />F] Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY <br />2 — 2 Z tNe Yv1t <br />0 51 up cf) (n plo in ) <br />O 0 <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHDa8-os <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />