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RECEIVED <br /> SAN J O A Q U I N MAR 16 2018 Environmental Health Department <br /> —COUNTY— PIJBLL/ RECORDS RELEASE APPLICATION <br /> Greatness grows here. Aim <br /> • Puff' iEwL �/ EHD LOG NUMBER: W-2)14 <br /> APPLICANT: Kirstin Hazeltine _ BUSINESSIAGENCY:Geographic SendcesInc(Gsq <br /> ADDRESS: PO Box 4517 CITYISTATEIZIP:Citrus Heights.CA95611 <br /> PHONE(1): (856)229-7015 PHONE(2): FAX OR E-MAIL: kirstinh@gsienvironmental.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 Kirstin Hazeltine DATE a/lsrzota <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 infoRsicehd.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 1940 to Present(2018) <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 p ) EHD USE ONLY <br /> FILES (Specific addresses only,address ran es will not be acce ted <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) e <br /> 1111 Navy Drive Stockton acs- �SUME <br /> ❑ 1 <br /> X Other Cleanup Site(Nan-LOP) <br /> • nX Hazardous Waste � ❑Dum <br /> Q Tiered Permitted Facility 2 'r/ GV AI <br /> nX Aboveground Tank <br /> nX UST (Monitoring/Removal) PWS <br /> Q Hazardous Materials <br /> nX Spill/Release Response ^ �t I <br /> WATER QUALRV <br /> Q Solid Waste Facility/Vehicle 4 <br /> nX Food Facility p� <br /> ❑Pool I Spa i .� O ` / �� RE MITIGATION <br /> ❑Dairy <br /> Q Land Use Application Sites <br /> HOUSING <br /> ❑Septic Pumper Truck/ s <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUPA <br /> ❑Housing Abatement 7 ASTIHM/HW <br /> ❑Motel/Hotel <br /> IJ Chicken Ranch/Dag Kennel CUPA <br /> g UST <br /> ❑Medical Waste Facility <br /> Tattoo/Body Piercing Sou-Wn TE <br /> ❑Waste Tire g <br /> nx Complaint <br /> Other(Please Specify): ❑AOOOUMING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*- <br /> 3't(� ►0 rr le . 7rMe rece' AL PAJQ 3f (c . <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 48.06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />