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USS <br /> SAN` MAR 2 ? 2010Environment Health Department <br /> s --COUNTY-- PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRONMENTAL WALTH AA <br /> Crectr,ess C Y.rrs herr., �+EI"kl4IT <br /> EMAIL �-Z1 Y/�/�� ■ <br /> EHD LOG NUMBER:VVV VVV <br /> APPLICANT: Ruben Mullins BUSINESS/AGENCY:California Regional Water Quality Control Board <br /> ADDRESS: 11020 Sun Center Drive#200 CITY/STATE/ZIP:Rancho Cordova <br /> PHONE(1): 530-417-7970 PHONE(2):g16-464.4552 FAX OR E-MAIL: wben.muninsCwaterboards.w.gov <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 Ruben Mullins "'�;ma,;.'�;,"° DATE sr272ola <br /> 1. List uo to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the types)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(&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. <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 3/27/2018 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH FILES (Specific <br /> (Specific addresses only,address ranges will not be accepted) EHD USE ONLY3'- I <br /> ❑X Underground Tank(UST) Street# Street Name <br /> city <br /> Cleanup Site(LOP) 1 [ICONSUMEROther Cleanup Site(Non-LOP) 1 749 E.Dr Martin Luther King Jr Blvd Stockton lAr r-. <br /> Hazardous Waste ND <br /> Tiered Permitted Facility 2 749 E. Cha er a •Stockton AJ° ❑D.- <br /> E]Aboveground Tank Q h <br /> nXX UST (Monitoring/Removal) pm <br /> Hazardous Materials a <br /> Q Spill/Release Response PI 6A h <br /> Solid Waste Facility/Vehicle q <br /> WATER QUALITY <br /> F1 Food Facility <br /> Pool/Spa <br /> ❑SITE Mmonnnory <br /> Dairy 6 <br /> Land Use Application Sites <br /> ❑Septic Pumper Truck/ a ❑HOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant ❑CUPA <br /> ❑Housing Abatement 7 AST/HM IHW <br /> El Motel/Hotel <br /> ❑Chicken Ranch/Dog KennelCUPA <br /> F1 Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing <br /> n Waste Tire e []SOLID WASTE <br /> Complaint <br /> Other(Please Specify): <br /> 1l1 ❑Axwnrleo <br /> "*BOXED AREA-EHD USE ONLY*** <br /> ° s +V 0 1h . <br /> ❑ Records provided by Staff-PPR Complete. staff Name: aHo aeras <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />