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DocuSign Envelope ID:24012D69-9490-4FC2-A1EOF E <br /> SANcJOA( 666���`+/LLL��� Y nvironmental Health Department <br /> -1'r COUNTY .JUL Uf 2018 PUBLIC RECORDS RELEASE APPLICATION <br /> • GrecrnEss aror. r,'�N <br /> PDNMEWU <br /> 00C a <br /> PPMMITAiG <br /> EHD LOG NUMBER: <br /> APPLICANT: La Tasha Laster-Mullins BUSINESS/AGENCY: PMZ Real Estate <br /> ADDRESS: 3515 Deer Park Drive, Suite A CITY/STATE/ZIP: Stoc ton CA 9521 <br /> PHONE(1): (209)482-4257 PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will c a t�1 16Irrange an appointment date and time to review the requeste�� �ec�arlc�s. <br /> SIGNATURE OF APPLICAN .�� DATE <br /> 1. List up to ten add resses,�0Aqrt;l%I6w.'0Agrt;l%Jow. 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. <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 FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> ®Underground Tank(UST) Street# Street Name city <br /> 1201 S. Center Stockton )A? <br /> Cleanup Site(LOP) J 1 ❑CoesumER <br /> 1 <br /> • )F1 Other Cleanup Site(Non-LOP) street <br /> Hazardous Waste 0 DAIRY <br /> Tiered Permitted Facility 2 ` 7 <br /> ®Aboveground Tank <br /> UST (Monitoring/Removal) <br /> PWS <br /> Hazardous Materials 3 <br /> Spill/Release Response <br /> ®Solid Waste Facility/Vehicle q 1 WaTER[loautt <br /> Food Facility I _ <br /> Pool/Spa ©*SrrE MmoAned <br /> ❑Dairy 6 <br /> ❑Land Use Application Sites <br /> Septic Pumper Truck/ 6 E]HOUSING <br /> Yard I Chemical Toilets <br /> ❑Wastewater Treatment Plant p CUPA <br /> ❑Housing Abatement T AST I HM I HW <br /> Motel/Hotel <br /> ❑Chicken Ranch I Dog Kennel p CUPA <br /> 6 <br /> Medical Waste Facility UST <br /> Tattoo/Body Piercing Souo WASTE <br /> ❑Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑A=uIrRNe <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 4846 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />