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RECEIVED <br /> SAN 10 A Q U I N MAY 0 2 28iia Environmental Health Department <br /> COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> • ( ted <br /> <. hercF.l�Rlf{iQ <br /> F'EAMfT 1L <br /> EHD LOG NUMBER: <br /> APPLICANT: Eric Ehlers BUSINESS/AGENCY:AKr Peerless <br /> ADDRESS: 1761 Arlington Blvd CITY/STATE/ZIP:EI Cerrito,CA 94538 <br /> PHONE(1): 510-529-9555 PHONE(2): FAX OR E-MAIL: ehlerse@aktpeedess.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 /> SIGNATURE OF APPLICANT Eric EhlersDATE 512120181. 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 inforalisicehd 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. 15%1 <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•S:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: All files <br /> Specific Date Range of Information Requested: From to <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) "� .:At wHr� Caysumsa <br /> ❑X Other Cleanup Site(Non-LOP) 1 149001W. Highway 12 L i <br /> • Q Hazardous Waste IiW,51h ti Cid <br /> UA <br /> X Tiered Permitted Facility p14850W. iV C3 � C-D Duav <br /> ❑ y Highway 12 Lodi V <br /> Q Aboveground Tank <br /> ❑X UST (Monitoring/Removal ❑PWS <br /> ❑ 3 14980W. Highway 12 Lodi <br /> X Hazardous Materials <br /> 0 Spill/Release Response <br /> ❑X Solid Waste Facility/Vehicle 4 14820W. Highway 12 Lodi B'WATER QUALrry <br /> ❑X Food Facility <br /> Q Pool/Spa SrtE Mm MN <br /> RX Dairy 5 14440W. Highway 12 Lodi <br /> ❑X Land Use Application Sites <br /> Q Septic Pumper Truck/ 6 ouslec <br /> Yard/Chemical Toilets <br /> ❑X Wastewater Treatment Plant COPA <br /> ❑Housing Abatement 7 AST/HM/HW <br /> ❑X Motel/Hotel <br /> ❑X Chicken Ranch/Dog Kennel OU PA <br /> 8 <br /> ❑X Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing <br /> $OIIDWASTe <br /> Q Waste Tire g <br /> ❑X Complaint <br /> ❑Other(Please Specify): c p Acceurmwc <br /> ID <br /> *"BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD4a-ea <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />