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f'4LjVE® EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG 2 20115 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENtAL HEALTH Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> RMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _Randy Kirby BUSINESSIAGENCY: IIS Tanx Inc. <br /> ADDRESS: 13330 Lonestar Thr CITY/STATE/ZIP: Grass Valley, CA 95949 <br /> PHONE(1): 916-870-5932 PHONE(2): FAX OR E-MAIL: randy kirbv@ustanx.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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT completed hy K Fplpy for applicant DATE 8/24/2016 <br /> 1. List up to ten addresses in the hpace below. Select the e(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <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$139 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: UST A &UST B FORMS ONLY <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) E]CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) 1 1001 E YOSEMITE MANTECA <br /> HAZARDOUS WASTE 0 DAIRY <br /> ❑TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> UST (MONITORING/REMOVAL) El <br /> PWS <br /> HAZARDOUS MATERIALS 3 <br /> SPILURELEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> I]FOOD FACILITY <br /> F�POOL/SPA ❑SITE MITIGATION <br /> ❑DAIRY 5 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT 0 CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTEL/HOTEL <br /> [-I CHICKEN RANCH/DOG KENNEL E]CUPA-UST <br /> F�MEDICAL WASTE FACILITY 5 <br /> TATTOO/BODY PIERCING <br /> WASTE TIRE ❑SOLID WASTE <br /> 9 <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): \ ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> Q 5IV. VVDVr 4,0dS iCF• - <br /> } <br /> -.tom <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: l^� ( <br /> EHD 48-06 <br />