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RECEIVED <br /> S A N J Q A Q U 1 y Environmental Health Department <br /> '� 2816Environmental <br /> RECORDS RELEASE APPLICATION <br /> XWZROWE <br /> EHD LOG NUMBER: �`6l7ol <br /> APPLICANT: Eric Ehlers BUSINESSIAGENCY:AKT Peerless <br /> ADDRESS: 1751 Arlington Blvd CITYISTATEIZIP:EI Cerrito,CA 94530 <br /> PHONE(1): 510-529-9555 PHONE(2): FAX OR E-MAIL: ehlerse@aktpeerless.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 Eric Ehlers DATE 5 '1c le, <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. S/6 <br /> Future file reviews by the same applicant may require a$152 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: All nle' <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only, ranges will not be acre ted <br /> 0 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) r. tu'• i rc 1r s�it{r /� ,2A Q'CONJ LJMEI' <br /> ®Other Cleanup Site(Non-LOP) 1 14900W. Highway 12 )It1rf b,�+ STI ' V 1 <br /> Fx Hazardous waste � ;t AIRY <br /> X❑Tiered Permitted Facility 2 14850W. Highway 12 Lodi IN a ` <br /> nX Aboveground Tank �J <br /> ®UST (Monitoring 1 Removal) yS}1 (jI�/Vt t l�/t ❑ J <br /> Q Hazardous Materials <br /> 3 14980W. Highway 12 Lodi k m , J <br /> Q Spill 1 Release Response <br /> {� © AT�ti QUALITY <br /> Solid Waste Facility 1 Vehicle 4 1482{ W Highway 12 Lod I `I <br /> ®Food Facility 1.1 � ne� j <br /> Q Pool 1 Spa (r 'n /\ `r ©SITE MrrlGnnor+ <br /> QDairy s 14440W. Highway 12 Lodi OL IF -. �-�-('U. N) <br /> Cj "f <br /> Land Use Application Sites <br /> /EjH6USING <br /> ❑X Septic Pumper Truck 1 6 <br /> Yard I Chemical Toilets <br /> wastewater Treatment Plant Q COPA <br /> Housing Abatement 7 AST 1 HM 1 HW <br /> 0 Motel/Hotel <br /> Chicken Ranch!Dag Kennel a " ErCUPA <br /> 8 UST <br /> 0 Medical Waste Facility +v <br /> 0 Tattoo/Body Piercing 5 n <br /> r <br /> �X Waste Tire g <br /> O Complaint <br /> Other(Please Specify): E]ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> vat"rA 4'11- ' ile4 ,I -- <br /> s <br /> ❑ Records provided by Staff-PPR Comple- . start Name: EHD 48-05 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />