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RECEIVED <br /> SAN _J 0 A Q U I N DEC 12 201? Environmental Health Department <br /> ---COUNTY— q PUBLIC RECORDS RELEASE APPLICATION <br /> ;recr� �s groll=_ he£l�V1FNfdES�fTALFf��slfH <br /> pow 7 <br /> PEIQfi1fP/SER t�,E9 1 I EHD LOG NUMBER: 661 <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services, Inc. (GSI) <br /> ADDRESS: PO Box 4517 CITYISTAI%/ZIP: Citrus Heights, CA 95611 <br /> PHONE(1): 916-385-0202 PHONE(2): FAX OR E-MAIL: kirstinh@gsienvironmental.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ,dam DATE 12/11/17 <br /> 1. List up to ten addresses in the spat 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 infona.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. Ile rr'22 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS)`/• V <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT only, g accepted) EHD USE ONLY <br /> FILES (Specific addresses address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name City 45r_% _ <br /> Cleanup Site(LOP) U /�1 _O Ut� ❑CoasUMea <br /> 724 E Grant Line Road Tracy 1 / <br /> • Other Cleanup Site(Non-LOP) CQ�% <br /> EZ Hazardous Waste 'Ar�r;- 0 DAIRY <br /> 9f Tiered Permitted Facility 2 8715 Grant Line Road W Tracy / <br /> Aboveground Tank Coop, <br /> P <br /> UST (Monitoring/Removal) �O ij'�7( <br /> PWS <br /> 3 1. <br /> Hazardous Materials 2401 N MacArthur Drive *Tracy <br /> Spill/Release Response ! N&ATER DWUTY <br /> Ri Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> Pool I Spa ns MincAnce <br /> Dairy 5 <br /> Land Use Application Sites <br /> E]HOUSING <br /> Septic Pumper Truck 1 5 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant cUPA <br /> Housing Abatement 7 AST I HM I HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel UPA <br /> 8 UST <br /> ❑Medical Waste Facility <br /> ❑Taftoo/Body Piercing ouo WASTE <br /> ❑Waste Tire 9 <br /> gComplalnt <br /> Other(Please Specify): ❑Accourmrvc <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY** <br /> • -1z-� FfZil �he� race n (t(Z ;n ne e t a (t e . M <br /> l • <br /> 'IPi-Do"d-ed flim1 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: eHD4sae <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />