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RATE REC9V E EHD LOG NUMBER <br /> WW''����11__���� SAN.IOAQUIN COUNTY rye^�J/(�/wp— <br /> MRY 2 2 2017 h �� ENVIRONMENTAL HEALTH DEPARTMENT VIP <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> '�ALH�&3F1 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> p"TdfT PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kirstin Hazeltine BUSINESSIAGENCY: Geographic Services Inc <br /> ADDRESS: PO Box 4517 CITYISTATEIZIP: Citrus Heights, CA, 95611 <br /> PHONE(1): (916)385-0202 PHONE(2): (856)229-7018 FAX OR E-MAIL: kirstinh@gsienvironmental.00m <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-/$$1139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT K LIfi qyp,? DATE _x199117 <br /> 1. List up to ten addresses in the space belov<Aelect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next 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. J <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 1940(or earliest developement) t0 Present <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name city <br /> CLEANUP SITE(LOP) ONGUMER <br /> 1111 Navy Drive Stockton <br /> R(OTHER CLEANUP SIM(NON-L 1 ' , n'I19 <br /> HAZARDOUS WASTE ri�( �p DAIRY <br /> TIERED PERMITTED FACILITY 2 � <br /> ABOVEGROUND TANK �^rf0 <br /> 0 UST (MONITORING/REMOVAL) 50L7 l]PWS <br /> 0 HAZARDOUS MATERIALS 0 <br /> EZSPILLIRELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE ' �„ \ r\ WATEa QUALITY <br /> 4 <br /> FOOD FACILITY <br /> 1T•V�J •V}_Or <br /> POOL/SPA m-MInGATION <br /> ❑DAIRY B O <br /> LAND USE APPLICATION SITES <br /> 9SEPnC PUMPER TRUCK/ HOUSING <br /> B f+Lk) s� I re , C/J <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT / / a/1 A Cal /r �,/t �/�/ VGA <br /> HOUSINGABATEMENT r 'Y/�{,� (.Jr y I A `1}A L <br /> ❑MOTEL/HOTEL <br /> EZ CHICKEN RANCH/DOG KENNEL &fCUPA-UST <br /> M MEDICAL WASTE FACIU`Y 8 <br /> ❑TATTOO/BODY PIERCING batOLID WASTE <br /> WASTE TIRE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): AccomWING <br /> 10 <br /> • -'BOXED AREA-EHD USE ONLY- <br /> 5-11 (�dke T"Corr-A w" ;!l DAI *'a t.��Fa L.Ze,At e <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br />