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RECEIVED <br /> SAN J OA Q U I N JUL 2 30116 Environmental Health Department <br /> C 0U I Y- -- PUBLI RECORDS RELEASE APPLICATION <br /> �irrio Y EMAIL 7-2 G�� <br /> EHD LOG NUMBER: <br /> APPLICANT: Heather N.Conner BUSINESS/AGENCY:Fulcrum Resources <br /> ADDRESS: 119 Emily Drive CITY/STATE/ZIP:Salisbury,MD 21804 <br /> PHONE (1): 443-736-3407 PHONE(2):410-603-1133 FAX OR E-MAIL: heather@frenviro.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 07221/20 18 <br /> 1. List up to ten addresses it 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 infoOsicehd.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. 3� <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 1970 to -,,Ole, <br /> ENVIRONMENTAL FILE ADDRESS U5 1 I°5, I� � Z3 1� <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> x]Underground Tank(UST) Street# Street Name City <br /> Cleanup t �" Consun1FR <br /> ❑OtherCleinute pSite 3820 West Lane Stockton 'po �yI <br /> 1 <br /> X Other Cleanup Site(Non-LOP) Q liJ <br /> 0 Hazardous Waste "'tyr <br /> DAIRY <br /> Q Tiered Permitted Facility 3826 West Lane to kto" <br /> ❑X Aboveground Tank / <br /> Q UST (Monitoring/Removal) ? 1+ V0 a� ❑PWS <br /> 3 3808 West Lane Stockton <br /> )( Hazardous Materials NO <br /> -1 Spill/Release Response �/✓ <br /> U r 5{— AT•R QUALITY <br /> Q Solid Waste Facility/vehicle 4 1413 Bourbon Street (UST) Stockton N <br /> ❑Food Facility ilk"q F 'e 1 <br /> ❑Pool/Spa ��� `,yet y�5�� ITE IncAnoN <br /> ❑Dairy 4040 West Lane (UST) Stockton 60w5 <br /> F]Land Use Application Sites F AjD ( <br /> Septic Pumper Truck I 6 E]HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant uPI <br /> ❑Housing Abatement 7 AST/HM/HW <br /> ❑Motel/Hotel <br /> Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing $OLID WASTE <br /> ❑Waste Tire 9 <br /> Q Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ^� —BOXED AREA-EHD USE ONLY— <br /> (':Z '� ' u rea'. <br /> -2 <br /> 8*: R <br /> -z r-11- W 00 -r ^ <br /> ❑ Records provided by Staff-PPR Complete. stat ame: /` / •1CE 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 vim, <br />