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RECEIVED <br /> SAN J OAQ U I N SUN 12 2018 Environmental Health Department <br /> �� ENVIRONMENTAL HMM PUBLIC RECORDS RELEASE APPLICATION <br /> PE1%M1T/8EF;Ki .E3 ON <br /> EHD LOG NUMBER: <br /> APPLICANT: VlCtoria Drake BUSINESS/AGENCY: ENGEO, Inc. <br /> ADDRESS: 17278 Golden Valley Parkway CITY/STATE/ZIP: Lathrop, CA 95330 <br /> PHONE(1): 626-408-4436 PHONE(2): N/A FAX OR E-MAIL: Vdrake engeo.Com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you t ange a appointment date and time to review the requested rec rds <br /> SIGNATURE OF APPLICANT �� �� DATE 06 t, Zolg <br /> 1. List up to ten addresses in thepace 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 14 Map—Description: ACUP <br /> Specific Date Range of Information Requested: From Tar)( lanA I , IG1150 to Tunc 12 120 1'9 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> In Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) n A?N al-3 -3\ 0 -3 i ❑cO SUMER <br /> Other Cleanup Site(Non-LOP) t MIALGrVvl roT" <br /> 3 .�q°IS - 21 .3318 <br /> Hazardous Waste ❑DA Rr <br /> Tiered Permitted Facility 2 <br /> to <br /> Aboveground Tank A <br /> CKUST (Monitoring/Removal) 3 n ` �y� ❑PWS <br /> 10 Hazardous Materials 1�t� `�-E�r� ,,✓-1 ' <br /> Spill/Release Response <br /> ❑WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 <br /> E]Food Facility <br /> ❑Pool/Spa ❑SITE MITIGATION <br /> F1 Dairy 5 <br /> Land Use Application Sites <br /> HousING <br /> Septic Pumper Truck I ❑ <br /> 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant ❑CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> F]Waste Tire 9 <br /> Ej Complaint <br /> Other(Please Specify): <br /> ❑ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> Q <br /> Records provided by Staff-PPR Complete. Staff Name: EHD 4806 <br /> 1868 E::. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 mvw.sjcehd.com <br />