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Adva c e v E I V 1 1 To: Fax: +1 (209' 4640138 Page 1 of 1 10/2412016 3:00 PM <br />■rDA SAN JOAQUIN COUNTY EHD LOG NUMBER <br />■■ ENVIRONMENTAL HEALTH DEPART <br />OCT 1868 East Hazelton Avenue, Stockton, CA 952f-Wa <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: ��- PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:Jackie Hyman p Advanced GeoEnvironmental, Inc. <br />�.ICt+04 BUSINESS/AGENCY: <br />ADDRESS: 3335 E. Miraloma Ave. #142, CITY/STATE/ZIP: Anaheim, CA 92806 <br />PHONE (1): 800-511-9300 PHONE (2) LOA P-7—IMP FAX OR E-MAIL: jhyman@advgeoenv.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- pGnl I ST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ,`_ DATE 24 October 2016 <br />1. List up to ten addresses in the space below. Select the type(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 $130 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />I Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENTF430, <br />FILE ADDRESSFIL <br />EHD USE ONLY <br />® UNDERGROUND TANK (UST) <br />Street Name <br />City <br />C CONSUMER <br />CLEANUP SITE (LOP) <br />® OTHER CLEANUP SITE (NON -LOP) <br />Sou <br />h Cherokee Lan <br />,Lodi -{�}/}�I j r <br />X] HAZARDOUS WASTE <br />DAIRY <br />❑ TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />I' <br />(,}` <br />omo �rJ ^ ^ <br />, /1.,.41//) <br />A ^ <br />�I✓ <br />` E] PWS <br />N <br />® UST (MONITORING/ REMOVAL) <br />K❑ HAzARDous MATERIALS <br />a SPILURELEASE RESPONSE <br />SOLID WASTE FACILITY/ VEHICLE <br />FOOD FACILITY(' <br />✓ <br />WATER QUALITY <br />�1 o <br />1 r 'i ) y V `rn <br />- SITE MRIGATION <br />POOL/SPA <br />F� DAIRY <br />Ij LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK/ <br />YARD/ CHEMICAL TOILETS <br />��C) <br />✓/ ✓ <br />�•/ <br />✓IV)\/ <br />V ✓ <br />VV <br />V <br />HOUSING <br />WASTEWATER TREATMENT PLANT <br />HOUSING ABATEMENTIVL, <br />MOTEIHDTEL <br />CUPA <br />IVI yn�( 1l]L <br />B <br />CUPA -Mg-T <br />✓IJP <br />CHICKEN RANCH / DOG KENNEL <br />❑ MEDICAL WASTE FACILITY <br />TATTOO/BODY PIERCING <br />WASTE TIRE <br />9 <br />SOLID WASTE <br />COMPLAINT <br />10 <br />❑ ACCOUNTING <br />F] OTHER(PLEASE SPECIFY): <br />***BOXED AREA - EHD USE ONLY*** <br />