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RECEIVED <br /> S A N iJ O A Q U I N ',,'Ay 319 f-Wrnvironmental Health Department <br /> "COUNTY-- PUBLIC RECORDS RELEASE APPLICATION <br /> Eil+fl/iRCl („ AL HEALTH <br /> 4 <br /> la0� <br /> r��t ;cs ,t <br /> s Jros )acr; <br /> PERMI Ju- <br /> AIL n <br /> � S� Y� EHD LOG NUMBER: <br /> APPLICANT: Lyn@ Black BUSINESS/AGENCY:Jacobs <br /> ADDRESS: 2525 Air Park Drive CITYISTATE/ZIP:Redding,CA 96001 <br /> PHONE(1): 530-229-3295 PHONE(2):530-680-5276 FAX OR E-MAIL: lyna black@jacobs.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac you to; a an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT � 17 DATE ��_l?u1 <br /> 1. List up to ten addresses In the'pace below. Address ranges WILL NOT be accepted. Select the typ>�-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@sicehd.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. (D <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 .�r t�-�} ce_t r i_ to r�t t rte <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FELE ADDRESS <br /> y g p <br /> FILES (Specific addresses only, ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) 'kMK6A ❑CONANER <br /> J Other Cleanup Site(Non-LOP) T ,�- �q <br /> fin <br /> HBYan1OUs Waste <br /> P <br /> Tiered Permitted Facility 2 t <br /> < � .1 uS )l <br /> Aboveground Tank 7 , I r.- { O <br /> UST (Monitoring/Removal) ❑PWS <br /> T <br /> ®Hazardous Materials � `n y 23 Tr` I � , <br /> �;Splll!Release Response , <br /> +` ��'� LATER 0 iri <br /> El Solid Waste Facility/vehlc:n W <br /> rl Food Facility '� ^� WeFaf C i No D .S <br /> ❑Pool/Spa am O Sir MITK.ATIOR <br /> I]Dairy <br /> Land Use Application S[let ib�J D <br /> I i�NM� ❑HousIN3 <br /> Septic Pumper Truck/ <br /> Yard!Chemical Toilets ' S- Tt�� b�. tt {r W d`_, <br /> Wastewater Treatment Plant` '4f-NW Ig COPA <br /> Housing AbatementJ7 ASTlHMfHW.S .°1 •Ttal.� r5�u„�, �;ki.;, /�.�p <br /> [I Motel/Holel i lD i <br /> ❑Chicken Ranch/Dog Kennel ®'COPA <br /> 171 Medical Waste Facility E UST <br /> Tattoo/Body Plarcing Q SOLID WASTE <br /> [�Waste Tire 9 <br /> Complaint <br /> Other(Please Specify) ElAccourrrwa <br /> to <br /> —BOXED AREA-EHD USE ONLY— <br /> ko 2 intiv -0 <br /> • Uv 2 2 X-7-0 v 1t 2,71 = <br /> D Records provided by Staff-PPR Complete.Stan Name: LW?Y LCD G >yD48OB <br /> 1868 E. Hazeiton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />