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RECEIVED <br /> SANs10AQUIN ,1LL 23 2�i , Environmental Health Department <br /> —COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br /> �c <br /> -,,_,m,:.�r ilrcnl nr,,.. 4ro,v•, iWEIA t� a � <br /> • - Il �1, YEMAIL <br /> EHD LOG NUMBER: VY <br /> APPLICANT: Heather N.Conner BUSINESS/AGENCY:Fulcrum Resources <br /> ADDRESS: tis Emily Drive CITYISTATEIZIP:Salisbury,MD 21804 <br /> PHONE(1): 443-73e-3407 PHONE(2):410-603-1133 FAX OR E-MAIL: heather@frenviro.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_ ..(� DATE 07/21/2018 <br /> 1. List up to ten addresses it 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 infoCa)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 2018 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( ponly, 9 p <br /> FILES (Specific addresses address ranges will not be accepted) EHD USE ONLY <br /> XJ Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) Q I]CONSVMER <br /> Q Other Cleanup Site(Non-LOP) 1 3820 West Lane Stockton <br /> • Q Hazardous Waste <br /> ❑x Tiered Permitted Facility 2 3826 West Lane Stockton <br /> ❑x Aboveground Tank <br /> Q <br /> UST (Monitoring/Removal) p p ❑PWS <br /> Q <br /> Hazardous Materials 3 3808 West Lane Stockton <br /> ❑x Spill/Release Response <br /> .t <br /> Q Solid Waste Facility/Vehicle 4 1413 Bourbon Street (UST) Stockton AMR DUALITY <br /> 1I�I� I <br /> ❑Food Facility 4,.rVtC LA I. 't <br /> ❑Pool/Spa ' � SI Mm.AnoN <br /> ❑Dairy 5 4040 West Lane (UST) Stockton L=lil <br /> ❑Land Use Application Sites A( <br /> ❑Septic Pumper Truck/ a ❑HOUSING <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant PfUPA <br /> ❑Housing Abatement T AST/HM/HW <br /> ❑Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> a <br /> ❑Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing Sou.WAsrn <br /> ❑Waste Tire 9 <br /> Q Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> '*'BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 4e-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />