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S A N ] O A Q U I N Environmental Health Department <br /> --- COUNTY - PUBLIC RECORDS RELEASE APPLICATION <br /> ` SUBMIT BY EMAIL <br /> EHD LOG NUIMBER: 9q311 <br /> APPLICANT: K m Belka BUSINESS/AGENCY:EMG <br /> ADDRESS: 10461 Mill Run Circle 41100 CITY/STATE/ZIP:Owings Mills,MD 21117 <br /> PHONE(1): 800-7d3-0660 x6535 PHONE(2): FAX OR E-MAIL: kbelkaC�emncorp con <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 ;-o I, <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 info(aDsicehd.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) a <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to Q <br /> ENVIRONMENTAL FILE ADDRESS O f 3 �� 1 C() -9 <br /> HEALTH DEPARTMENT H <br /> FILES (Specific addresses only, address ranges will not be accepted) USE OLy <br /> X❑Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) 5T m I�IW ❑CONSUMER, <br /> FX Other Cleanup Site(Non-LOP) 1 (�]5 West Valpico Road Tracy I j r / HVV <br /> ❑Hazardous Waste o upol\co ❑ <br /> 1 vV J 1. PP. DAIRY <br /> 171 Tiered Permitted Facility 2 <br /> F]Aboveground Tank <br /> Q UST (Monitoring I Removal) ❑PWS <br /> Q Hazardous Materials 3 <br /> Spill/Release Response <br /> ❑WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> El Pool/spa ❑SITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> Septic Pumper Truck/ 6 L1 HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM I HW <br /> 71 Motel/Hotel <br /> F Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 6 UST <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> F]Waste Tire 9 <br /> Complaint <br /> F]Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> S 113 1 - -mcCec{ A C D' . <br /> Hm-s'l2Usz 112 f+VV - k " 13 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: 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 />