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SAN JO A QA� Health Department <br /> -.---COUNT (' --- � ,Z2 PUBLIC RECORDS RELEASE APPLICATION <br /> SUBMIT BY EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: Frank Trinidad BUSINESS/AGENCY:Odic Environmental <br /> ADDRESS: 3255 Wilshire Blvd#1510 CITY/STATE/ZIP:Los Angeles,CA 90010 <br /> PHONE (1): 213-380-0090 ,PHONE(2): FAX OR E-MAIL: frankt(Godicenv 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 os.ii9--is <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 infoPsicehd.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) 913k <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From ty>c; to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD <br /> �USE O2 <br /> N L <br /> QX Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) t►maPttw 1 E]CONSUMER <br /> QOther Cleanup Site(Non-LOP) 1 1668 EI Pinal Dr Stockton I C <br /> c)Lsp <br /> ❑X Hazardous Waste <br /> ❑DAIRY <br /> FX Tiered Permitted Facility 2 <br /> Q Aboveground Tank <br /> Q UST (Monitoring/Removal) ❑PWS <br /> Q Hazardous Materials 3 <br /> Q Spill/Release Response <br /> Solid Waste Facility/Vehicle 4 ❑WATER QUALITY <br /> Food Facility <br /> Pool/Spa ❑SITE MITIGATION <br /> Dairy 5 <br /> Q Land Use Application Sites <br /> Q Septic Pumper Truck/ ❑6 HOUSING <br /> Yard/Chemical Toilets <br /> [_X1 Wastewater Treatment Plant CUPA <br /> F]Housing Abatement 7 AST/HM/HW <br /> ❑ Motel/Hotel <br /> Chicken Ranch/Dog Kennel ❑CUPA <br /> Q Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing <br /> ❑SOLID WASTE <br /> ❑X Waste Tire 9 <br /> ❑X Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> 151,12241F­ aC <br /> 2nCA' Hinz - PPOrn3`39.5li!o� r0 <br /> ❑ Records provided by Staff-PPR Complete. Staff N e: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />