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RECEIVED <br />SAN JO A H I Nja 3 l 2018 Environmental Health Department <br />COUNTY — (L� tr`r ��(!,� PUBLIC RECORDS RELEASE APPLICATION <br />WTAL <br />• 06Wm�JEf r'a`i I'f BY EMAIL � <br />EHD LOG NUMBER:Oq-4.�> V <br />APPLICANT: Betsy Hosko BUSINESS/AGENCY: GHD <br />ADDRESS: 209 Gothic Court Suite 109 CITY/STATE/ZIP: Franklin, TN 37067 <br />0 <br />9 <br />PHONE (1): 615-721-0669 PHONE (2): FAX OR E-MAIL: betsy.hosko@ghd.corn <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 , i <br />1. List up to ten addresses in the spa :e 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@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: Z List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES(Specific <br />addresses <br />FILE ADDRESS <br />only,address ranges will not <br />be accepted) <br />EHD USE ONLY <br />QX Underground Tank (UST) <br />. 48-06 <br />Street # <br />Street Name <br />City <br />1 <br />2321 <br />W Washington St <br />Stockton <br />ij\n 1 i ❑ CONSUMER <br />N( p <br />Cleanup Site (LOP) <br />R Other Cleanup Site (Non- P) <br />Q Hazardous Waste <br />Q Tiered Permitted Facility <br />RX Aboveground Tank <br />2 <br />— <br />{ I, f <br />' ` A `x'11 LJ M ,. <br />❑ DAIRY <br />❑ PWS <br />R UST (Monitoring / Removal) <br />Q Hazardous Materials <br />3 <br />❑X Spill / Release Response <br />Q Solid Waste Facility / Vehicle <br />4 <br />WATER QUALITY <br />❑ Food Facility <br />SITE MITIGATION <br />❑ Pool / Spa <br />❑ Dairy <br />5 <br />Q Land Use Application Sites <br />❑ HOUSING <br />Q Septic Pumper Truck /6 <br />Yard / Chemical Toilets <br />Q Wastewater Treatment Plant <br />&KUPA <br />❑ Housing Abatement <br />7 <br />AST/HM I HW <br />❑ Motel/Hotel <br />8 <br />UPA <br />UST <br />❑ Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />❑ Tattoo/Body Piercing <br />❑ Waste Tire <br />9 <br />SOLID WASTE <br />❑ Complaint <br />10 <br />❑ ACCOUNTING <br />❑ Other (Please Specify): <br />***BOXED AREA - EHD USE ONLY*** <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F V9 464-0138 1 www.sjcehd.com <br />F -211111=11110"A", It SO <br />El .. . . -. . Complete. ` ... <br />. 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F V9 464-0138 1 www.sjcehd.com <br />