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ECEIVED <br /> SAN J O A Q U N Environmental Health Department <br /> C O U i J T Y----- - JUL 30 2018 PUBLIF RECORDS RELEASE APPLICATION <br /> ElilV1RO � 1/' <br /> • PENMR TV EHD LOG NUMBER: ��� <br /> APPLICANT: TonyaScheftner BUSINESS/AGENCY: _PQ„"V(-4N30 '% �11 �rle2�lZt1q Trot - <br /> ADDRESS: PO Box 77 CITY/STATE/ZIP: Mt.Hermon,CA M041 <br /> PHONE(1): 209-770-0731 PHONE(2): FAX OR E-MAIL: tscheftner@petralogix.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 a appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ��/ DATE 7/30/2018 <br /> 1. List up to ten addresses in the spat elo, Addres 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(QDsicehd 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 to <br /> ENVIRONMENTAL FILE ADDRESS CD �� <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) D ) COS� oNsuueR <br /> Q Other Cleanup Site{Non-LOP <br /> 31 N Pacific Ave Lodi <br /> • 14M kv <br /> R Hazardous Waste <br /> ❑DAIRY <br /> I^I Tiered Permitted Facility 2 <br /> ®Aboveground Tank <br /> Q UST (Monitoring/Removal) ❑PVVS <br /> Q Hazardous Materials 3 <br /> Q Spill/Release Response <br /> Q Solid Waste Facility/Vehicle 4 El WATER QUALITY <br /> Q Food Facility <br /> Q Pool/Spa Sne MITIGATION <br /> ❑Dairy 5 <br /> ©Land Use Application Sites <br /> Septic Pumper Truck/ 6 ❑HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant UPA <br /> F]Housing Abatement 7 AST!HM/HW <br /> MoteVHotel <br /> Chicken Ranch/Dog Kennel �- �aCUPA <br /> Medical Waste Facility <br /> $ UST <br /> ❑Tattoo/Body Piercing <br /> ❑SouO Wasre <br /> Waste Tire g <br /> nX Complaint <br /> Other(Please Specify): 0 ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete.start Name: EHD 4"6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wAm1-sjcehd.com <br />