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'RECEIVE <br />Environmental Health <br />SKJOAQUIN ., t Department <br />COUNTY �`"�Y 1' 1 2MB PUB&IC RECORDS RELEASE APPLICATION <br />�kp• �,_, ::.r;: Gre0t,Ie°ss gror.s here-NVIRONME 9a9bI 1T NAlL A�(MD*7 <br />REKNIT/S EHD LOG NUMBER. <br />APPLICANT: John Sellman BUSINESS/AGENCY:ATC Group Services, LLC <br />ADDRESS: 1117 Lone Palm Avenue, Suite 201B CITY/STATE/ZIP: Modesto, CA 95351 <br />• <br />PHONE (1): 209-579-2221 PHONE (2):209-872-5291 FAX OR E-MAIL: john.seliman@atcgs.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 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(a-)slcehd.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 any to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />FILE ADDRESS <br />only, address ranges will not <br />y 9 <br />be accepted) <br />p <br />IC -D <br />EHD USE ONLY <br />X❑ Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />j1 <br />2650 <br />N. MacArthur Dr. <br />Tracy <br />❑ CONSUMER <br />.rt <br />Cleanup Site (LOP) <br />FXj Other Cleanup Site (Non -LOP) <br />XJ Hazardous Waste <br />Q Tiered Permitted Facility <br />Q Aboveground Tank <br />2 <br />A <br />i Asill LAST <br />❑ DAIRY <br />❑ PWS <br />XJ UST (Monitoring / Removal) <br />Q Hazardous Materials <br />0 Spill / Release Response <br />Solid Waste Facility / Vehicle <br />Food Facility <br />3 <br />n t <br />Q <br />4 <br />," �— C <br />t.� yy �q 7 <br />WATER QUALITY <br />MISITE MITIGATION <br />Pool / Spa <br />❑ Dairy <br />5 <br />Land Use Application Sites <br />6 <br />❑ HOUSING <br />Septic Pumper Truck / <br />Yard / Chemical Toilets <br />Wastewater Treatment Plant <br />COPA <br />Housing Abatement <br />7 <br />AST / HM / HW <br />❑ Motel/Hotel <br />6 <br />CUPA <br />UST <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />F] Tattoo/Body Piercing <br />R Waste Tire <br />g <br />11 SOLID WASTE <br />F] Complaint <br />❑ ACCOUNTING <br />Other (Please Specify): <br />10 <br />—BOXED AREA - EHD USE ONLY— <br />j;_'7 <br />NLY— <br />j;_P"tiLl,Cr�jCA r�e�A C��iP�t2u� 4 IAA :L°W6 i el <br />❑ hecords 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 IF 209 464-0138 1 www.sjcehd.com <br />