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EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAY U 9 2017 &VIRONMENTAL HEALTH DEPARTMENO 86113 1868 East Hazelton Avenue, Stockton, CA 95205-6232 V 6 1 1 3 <br /> ENVIRONMENTAL HEAfthone: (209)468-3420 Fax: (209)464-0138 Web: www.s-cehd.com Email: info(a,sicehd.com <br /> PERMIT/SERVICE'S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: HEATHER GROTTY BUSINESSIAGENCY: ESCREENLOGIC <br /> ADDRESS: 11249 GOLD COUNTRY BLVD,#165 CITYISTATEIZIP: GOLD RIVER, CA 95670 <br /> PHONE (1): 916-288-8977 PHONE (2): FAX OR E-MAIL: H,cROTry ESCREENLOGIGCOM <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by Staff, Dom M _ DATE May 9, 2017 <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 list <br /> 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 above or email to info s'cehd.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 above. <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 $139 deposit prior to review. rj <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 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only, address ranges wrli not be accepted) E D USE QN LY I <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ` <br /> 3718 W GRANT LINE RD N RACY C E]CONSUMER <br /> ®OTHER CLEANUP SITE(NGN-LOP) � <br /> ®HAZARDOUS WASTE N� t�] • fV ij j <br /> ®TIERED PERMITTEC FAC IUTYAI r TRACY <br /> 3230 W GRANT LINE RD Q,5-f-(""r— 0y ❑oAlar <br /> ®ABOVEGROUND TANK <br /> ��n`y, V' fl f.� f f�� <br /> ®UST (MONITORING 1 RER70 }4 r`f G-/ (J(J <br /> ®HAZARDOUS MATERIALS a 3260 W GRANT LINE RD TRACY N� -!-Ir <br /> E]Pws <br /> (` • F.®SPILLIRELEASE RESPONSE <br /> E]SOLID WASTE FACILITY!VEHICLE A ®WATER QUALITY <br /> F1 FOOD FACILITY <br /> POOL/SPA <br /> ®DAIRY $ SITE MIT[rATION <br /> F-i LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRICK 1 6 HOUSING <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT 7 <br /> ®CUPA <br /> MOTELIHOTEL <br /> CHICKEN RANCH I DOG KENNEL ®CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOOIBODY PIERCING <br /> F]WASTE TIRE 9 []SOLID WASTE <br /> ®COMPLAINT <br /> OTI-ER(PLEASE SPECIFY: <br /> 10 ACCOUNTING <br /> "'BOXED AREA-EHD USE ONLY" <br /> 0 r Xc r� c ry v, PE5- <br /> - <br /> 0 Records provided by Staff-PPR Complete. staff Name: <br />