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EIv Y E0 SAN JOAQUIN COUNTY 2 EHD LOG NUMBER <br /> MAY <br /> +t Z 201!� ^J)//mow/_ �(/'�(/�1// <br /> 7 ENVIRONMENTAL HEALTH DEPARTMENT `rV — - <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �ALMI�,lf Mi Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> pEl�smUsE ` PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kirstin Hazeltine BUSINESS/AGENCY: Geographic Services Inc <br /> ADDRESS: PO BOX 4517 CITYISTATE/ZIP: Citrus Heights, CA, 95611 <br /> PHONE(1): (916)385-0202 PHONE(2): (856)229-7018 FAX OR E-MAIL: kirstinh@gsienvironmental.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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT K ,H qyd?Q DATE x,122117 <br /> 1. List up to ten addresses in the space belo . elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next 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. ��3I <br /> Future file reviews by the same applicant may require a$139 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 1940(or eadiest developement) to Present <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNOERGRGUND TANK(UST) Street# Street Name City <br /> FWONSUMER <br /> CLEANUP Sim(LOP) , 1111 Navy Drive Stockton " � lAp�) 1�t��( <br /> • RrOTHER CLEANUP SITE <br /> V HAZARDOUS WASTE DAIRY <br /> TIERED PERMITTED FACILITY 2 <br /> I,-Z-� ABOVEGROUND TANK <br /> 9f UST (MONITORING/REMOVAL) PWS <br /> 9 HAZARDOUS MATERIALS 3 <br /> VSPILL/RELEASE RESPONSE AL <br /> ��1y��7 WATRQ <br /> 9SO110 WASTE FACILITY/VEHICLE 4 rY I JJ�,/( <br /> EZFOOD FACILITY CID n�Y� <br /> POOL/SPA SITE MITIGATION <br /> n DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 11HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT UPA <br /> ❑HOUSING ABATEMENT r <br /> MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY 8 <br /> ❑TATTOO/BODY PIERCING OUD WASTE <br /> EdWASTETIRE <br /> 9 <br /> I?COMPIAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> 16 <br /> —BOXED AREA-EHD USE ONLY-" <br /> • 5`la 1� 4At\c Z Lo;r-e� <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br />