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SAN 10AQUI ?"CE'VED. <br /> rtvfronmental Health Department <br /> —COUNTY-- NOV 027 201 (uud PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness 9rci h'-,:JE11 <br /> • PEROFFg EHD LOG NUMBER: <br /> APPLICANT: Beniamin Peterson BUSINESS/AGENCY: McGinley&Associates Inc <br /> ADDRESS: 815 Maestro Drive CITY/STATE/ZIP: Reno, NV 89511 <br /> PHONE(1): 775-82q-9945 PHONE(2): 775-366-5406 FAX OR E-MAIL: bpeterson(docclin.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 DATE <br /> 1. List un 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(rDsicehd.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 hot 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) w <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From beginning to present <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be ecce ted <br /> [x Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) E]CorvsuMEN <br /> t 1010 Industrial Drive Stockton,CA <br /> nX Other Cleanup Site(Non-LOP <br /> Q Hazardous Waste DAIW. <br /> E]Tiered Permitted Facility 2 <br /> Q Aboveground Tank <br /> Q UST (Monitoring/Removal) PWS <br /> i�Hazardous Materials 3 <br /> Q Spill/Release Response <br /> Solid Waste Facility/Vehicle 4 ® ATEa euurtr <br /> Food Facility <br /> Pool/Spa SITE MITGADON f <br /> ❑Dairy 6 <br /> ❑Land Use Application Sites <br /> ❑Septic Pumper Truck/. 6 ❑HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUPA <br /> ❑Housing Abatement T AST/HM/HW <br /> ❑Motel/Hotel <br /> Chicken Ranch/Dog Kennel UPA <br /> a <br /> Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing SOLID WASTE <br /> ❑Waste Tire g <br /> Q Complaint <br /> Other(Please Specity): ❑AccooNTluc <br /> t0 <br /> * BOXED AREA-/n1EHD USE ONLY— <br /> • It' -t� '�NYAItQ n rlr c; - ���. I-ca <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EH046-06 <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />