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RECEIVED <br /> SAN )O A p U I Nurr� 2 ? 2018 Environmental Health Department <br /> • E'dVItZONMt."d-fAL E PUBLIC RECORDS RELEASE APPLICATION <br /> PEI`WIT/SEf?A! IT BY EMAIL T'] <br /> EHD LOG NUMBER: VV <br /> APPLICANT: Justin Bauer BUSINESSIAGENCY:Trileaf Environmental <br /> ADDRESS: 2121 West Chandler Boulevard#108 CITY/STATE/ZIP:Chandler,AZ 85224 <br /> PHONE(1): 480-850-0575 PHONE(2): FAX OR E-MAIL: i.bauer@lrileaf-com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you tp arrange 9 appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT 44AL DATE U5o,e Z Z, Zo ! 8' <br /> 1. List up to ten addresses in the.4pace below. Addr ss 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(asicehd.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 If 0) <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 to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 P EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be accepted) <br /> QX Underground rank(UST) Street# Street Name City <br /> Cleanup Site(LOP) I DQ ❑couevmea <br /> • 707 Yosemite Ave. Manteca W <br /> ❑X Other Cleanup Site(Nan-LOP) <br /> Q Hazardous Waste <br /> I]Duav <br /> Qx Tiered Permitted Facility 2 <br /> ❑X Aboveground Tank NM i�W (�`) LO( <br /> Q UST (Monitoring/Remove) L]MS <br /> Ha2ardeea Materials 3 <br /> Q Spill I Release Response <br /> ((��, raa quunr <br /> I�Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> ❑Pool/Spa ns Mmwnon <br /> ❑Dain fi <br /> ❑Land Use Application Sites <br /> Septic Pumper Truck/ ❑Hovmnc <br /> fi <br /> Yard I Chemical Toilets <br /> ❑Wastewater Treatment Plant &KUPA <br /> ❑Housing Abatement 7 AST I HM I HW <br /> ❑Motel/Rotel <br /> ❑Chicken Ranch/Dog Kennel NjtUPA <br /> F-1medicalWaste Facility a UST <br /> ❑Tattoo/Body Piercing ouo wasre <br /> rix Waste Tire g <br /> Q Complaint <br /> Other(Please speclry): ❑Accouxnas <br /> 10 <br /> —BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. staff Name: Eno 48-06 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />