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RECEIVED <br /> SA NIJ OAQ U I N ��L �} Environmental Health Department <br /> ---COUNTY--- PUBLIC RECORDS RELEASE APPLICATION <br /> 11 ttC'E�flfl�ls <br /> r�-rev"• l�Yt''9(nr• ;1rz7�Nk <br /> POINIiT1101 �j{3Y EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: Heather N.Conner BUSINESS/AGENCY:Fulcrum Resources <br /> ADDRESS: 119 Emily Drive CITY/STATE/ZIP:Salisbury,MD 21804 <br /> PHONE(1): 443-736-3407 PHONE(2):410-603-1133 FAX OR E-MAIL: heather@frenviro.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 APPLICANTDATE 07,2)1201b1. List up to ten addresses i1 J � 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 infoftsicehd 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 staffat the expense of the applicant. <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. V. <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 197D to 2018 <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <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) Nr,' r ❑CONSUMER <br /> Fx Other Cleanup Site(Non-LOP) 1 3820 West Lane Stockton <br /> • QX Hazardous Waste <br /> Fx Tiered Permitted Facility 2 3826 West Lane Stockton ❑DAIRY <br /> Q Aboveground Tank <br /> ❑X UST (Monitoring/Removal) (h C PWS <br /> ❑ <br /> Q Hazardous Materials 3 3808 West Lane Stockton <br /> Q Spill/Release Response <br /> QSolid Waste Facility/Vehicle 4 1413 Bourbon Street (UST) Stockton] ATERQUALITY <br /> ( on <br /> 7 Food Facility 70,.� n�t rC�t;4'` a 0 <br /> Pool/Spa 'M, ITE MITIGATION <br /> ❑Dairy 5 4040 West Lane (UST) Stockton L;:f <br /> Land Use Application Sites Z96 t'6/' <br /> septic Pumper Truck! 6 P00010-5—q- <br /> ''1[ W 1 -5``"C ` E]HOUSING <br /> Yard/Chemical Toilets ROO 00 Q —� <br /> Wastewater Treatment Plant /1 n LjrU r!` --T UPA <br /> Housing Abatement 7 I V✓ 1 l AST/HM/HW <br /> F1 Motel/Hotel PW 54% <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility a UST <br /> Tattoo/Body Piercing <br /> S <br /> 0 Waste Tire OLID WASTE <br /> 9 <br /> Q Complaint <br /> ❑Other(Please Specify): ACCOUNTING <br /> 10 <br /> y , q <br /> ***BOXED AREA-EHD USE ONLY <br /> • �'Z '��a(;,ai m 9?/, ?n �a•,Zv' iiZ C7 .� 0..+ �Wl i <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />