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DECEIVE® <br /> MAY 3 0 2i;►�nvironmental Health Department <br /> SANJOAQUIN � <br /> C OU NTY— EltYIR(INtAES6TAL i•}>;,4LT1i PUBLIC RECORDS RELEASE APPLICATION <br /> 3Icatnoss jrows here PEllll AIL (NT02. <br /> EHD LOG NUMBER: <br /> APPLICANT: Lyre Black BUSINESS/AGENCY:Jacobs <br /> ADDRESS: 2525 Air Park Drive CITYISTATE/ IP:Redding,CA 96001 <br /> PHONE(1): 530-229-3295 PHONE(2):530.680-5276 FAX OR E-MAIL: lynablack@iacobs.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contac you to afrapne an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ` DATE J/^o( ; <br /> 1. List up to ten addresses in the e below. Address ranges WILL NOT be accepted. Select the tyfiles from the <br /> list below by checking the appropriate box(es). At least one Nle type MUST be selected. Fax to(2091464-0138,mall to the <br /> address Indicated below-or email to infoRsicehd.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 exIBL 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 G' r oc_r} ce c;✓'•{ to r,O rife# <br /> ENVIRONMENTAL FELE ADDRESS <br /> HEALTH DEPARTMENT y 9 p <br /> FILES (Specific addresses only, ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name city <br /> Cleanup Slle(LOP) ihl ❑Coasuvaa <br /> Other Cleanup Site(Non-LOP) t (p16D W, Llrl f 1 il' ` •�•�- <br /> Hazardous Waste <br /> ❑Tiered Pemiilled Facility 2 N'F'F• <br /> 'rvr Aboveground Tank <br /> z1gis 5 M kc-, A tzc 0" II <br /> :UST (Monitoring l Removal) ❑ WS <br /> ' Z p P <br /> Hazardous Malodals r 1 Gp� <br /> �9E33 Tc�,•:. <br /> 1j,Spill/Release Response - - <br /> � r� 1WstEnewury <br /> Solid WEIFacility/Vehicip a 1 <br /> Food Facllly lA), t- �s pfJI(" I CD <br /> Pool/Spa kkw Rio MITaBiION <br /> J G <br /> � 1 <br /> Dairy $ ,. •� \ \l S[ <br /> Land Use Application Sass to J O <br /> Sepik Pumper Truck/ FN(t�4y Hauuq <br /> a , FF <br /> Yertl I Chemical Toilets {.yfbl{ S, '�('A <br /> Wastewater Treatment Plant kM NW [.j CUPA <br /> Housing Abatement T �5 X41 / `y &V k�L, ,�'F• FSTrHMIHW <br /> LJ Mole VHotel V <br /> Chicken Ranch/Dog Kennel 12CUPA <br /> a <br /> Medical Waste Facility UST <br /> Taepo/Body PlarcinB <br /> ❑Souo ws*s <br /> Waage The o <br /> Q Complalat <br /> Other(Please Speedy) ❑Aceomrtieo <br /> so <br /> —BOXED AREA-EHD USE ONLY*" <br /> ❑ Records provided by Staff-PPR Complete,Sot Name: END 48-0e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />