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RECEIVED <br /> SAN J O A Q U I N MAR 16 2018 Environmental Health Department <br /> COUNTY PUBLIC RECORDS RELEASE APPLICATION <br /> HESS yr[`V;E rn.LAY'rwA <br /> • PEAMIT L <br /> EHD LOG NUMBER Y _ <br /> APPLICANT: Kirskn Hazeltine _ BUSINESS/AGENCY:Geographic Services Inc(GSH <br /> ADDRESS: PO Box 4517 CITY/STATE/ZIP:Citrus Heights,CA95611 <br /> PHONE(1): (856)229-7018 PHONE2 : FAX OR E-MAIL: kirsnnh <br /> ( ) @gsienvironmental.mm <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 Kirstin Hazeltine DATE 3n5/201e <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 <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(cDsicehd.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 1940 to Present(2018) <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 p <br /> FILES (Specific addresses only, address ranges will not be accepted) EHD USE ONLY <br /> ❑X Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) l)p CgoesUMER <br /> QX Other Cleanup Site(Non-LOP) 1 1111 Navy Drive Stockton II; uidviii 0-4m. <br /> • ❑X Hazardous Waste <br /> ❑OaiRv <br /> nX Tiered Permitted Facility 2 <br /> ❑X Aboveground Tank j/"1 LA1At4 I-U"t IoW u5Z '+1 <br /> ❑X UST (Monsoring/Removal) ❑PWS <br /> Q Hazardous Materials 3 <br /> ❑X Spill Release Response <br /> nX Solid Waste Facility/Vehicle 4 7J I I(v rA^/ {�t�WATeR qunun <br /> nX Food Facility I "✓ /r '- ' <br /> ❑Pool/Spa &KIM Mrr anon <br /> ❑Dairy 6 <br /> nX Land Use Application Sites <br /> F]Septic Pumper Truck/ 6 ❑HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant CUPA <br /> ❑Housing Abatement 7 AST/HM IHW <br /> ❑Matel/Hotel <br /> ❑X Chicken Ranch/Dog KennelCUPA <br /> Medical Waste Facility 6 UST <br /> Tattoo/Body Piercing <br /> Sotto Wnsra <br /> Waste Tire e <br /> FX Complaint <br /> Other(Please Specify): O AIXAUmINe <br /> 10 <br /> '*'BOXED AREA-EHD USE ONLY*'* <br /> 3 t(st - <br /> LP--'tle 4iiMe1 fete oA 9L PWA, 7 ,c A XA L C <br /> 0 Records provided by Staff-PPR Complete. Staff Name: EHD 48.06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />