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°'- c° SAN J0AQUIN <br />COUNTY <br />APPLICANT: Mark Milani <br />ADDRESS: 2655 Stanwell Drive, Suite 105 <br />Environmental Health Department <br />PUBLIC RECORDS RELEASE APPLICATION <br />SUBMIT BY EMAIL <br />EHD LOG NUMBER: <br />BUSINESS/AGENCY: Milani & Associates <br />CITY/STATE/ZIP: Concord.. CA 94520 <br />PHONE (1): 925-674-9082 PHONE (2): 925-330.7642(mobile) FAX OR E-MAIL: mark.milani@milani-eng.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 APPLICANT <br />DATE June 21, 2022 <br />1. List up to ten addresses in the space 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 ehdfilereviewCZDsjgov.org. Applications received after 3:00 pm will be processed the <br />next 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 />SEPTIC AND WELL PERMITS ARE AVAILABLE FOR REVIEW ONLINE AT: https://www.sjgov.org/department/envhealth/public-records <br />Electronic Information: ❑ List M Map — Description: Vesting Tentative Map, Sheet 4 (shows residence and location of septic system for reference) <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />p <br />onlyaddress ran es will not <br />y 9 <br />be acce ted <br />p ) <br />EHD USE ONLY <br />❑ Underground Tank <br />Street # <br />Street Name <br />City <br />(UST) Cleanup Site <br />❑ CONSUMER <br />LOP <br />1 <br />18851 <br />Queirolo Rd <br />Lathrop <br />❑ Other Cleanup Site <br />❑ DAIRY <br />Non -LOP <br />❑ Hazardous Waste <br />2 <br />❑ Tiered Permitted Fadlity <br />_ <br />❑ Aboveground Tank <br />❑ PWS <br />❑ UST (Monitoring / <br />3 <br />Removal <br />❑ Hazardous Materials <br />❑ WATER QUALITY <br />❑ Spill / Release <br />4 <br />Response <br />❑ Solid Waste Facility / <br />s <br />❑ SITE MmGAnON <br />Vehicle <br />❑ Food Facllity <br />❑ Pool / Spa <br />❑HOUSING <br />El <br />El Land Use Application <br />6 <br />Sites <br />El Septic Pumper Truck / <br />❑COPA <br />Yard / Chemical Toilets <br />7 <br />AST / HM / HW <br />❑ Wastewater Treatment <br />❑ CUPA <br />Plant <br />❑ Housing Abatement <br />s <br />UST <br />❑ MoteVHotel <br />❑ Chicken Ranch / Dog <br />9 <br />❑ SOLID WASTE <br />Kennel <br />❑ Medical Waste Facility <br />❑ TattooBody Piercing <br />❑ ACCOUNTING <br />❑ Waste Tire <br />❑ Complaint <br />,o <br />x❑ Other (Please Specify <br />r <br />cord/Do <br />estic Water Well Driller WCF <br />Septic Tank/Leach field pedmit <br />***BOXED AREA - EHD USE ONLY*** <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 />