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221 06/2112016 08:53 (FAX) P.0011001 <br />KE <br />'h <br />��ATE Rei✓ I .'.c y t1�r 6 '' EHD LOG NUMBER <br />611411 <br />SAN JOAQUIN COUNTY <br />ENVIROHMENTAL HEALTH DEPARTftirtEKT <br />aW . l <br />_s.� - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 r i <br />Telephone: (209) 466.3420 Fax: (209) 464-0138 Web. vNvw.sjgov.orglehd <br />�t�� Ii�CIl �J�i��I_ HEALTH IgURLIC RECORDS RELEASE APPLICATION <br />FRf;�ilTrv�,�ahitr•�� <br />APPLICANT. Erin Rottacker RUSINIESSIAGEKCY: advanced Geo Environmental, Inc. <br />ADDRESS: 837 Shaw Rd CITY/STATE/ZIP: Stockton, Cha 95215 <br />PHONE (1): 209 467 1006 PHONE (2): FAX OR E-MAIL: erottackaLQadvgaoenv.com <br />Please allow 10 buslne�s days from date of applicatlon subm, IffEl for the records to be available. <br />Staff: will cots ou to arrange an appointment date and time to review the roquested records. <br />® CHECK BOX TO EXPr;Pl. vtOEFE (CASH OR CHECK ONLY) - REQUEST PROCESSED IIS 3 BUSINESS DAYS <br />SIG14ATURE OF APPLICANT DATE 21 dune 2016 <br />1. List up to ten addresses in the space below. Se ect 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 263) 464-0138 or mall to the address Indicat d above. Address <br />ranges will not be accepted. Application€ received after 3:00 prn Mll be processed the next buelnzas day, <br />2. For esasietence In identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. The C -:KD Will notify the applicant if any EHD Files exlet. An appointment for review will be conrirmed approximately ten (10) <br />days after receipt of application. The flies 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 $130 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR.REVIEW: MONDAY -FRIDAY 3:00 AMZ:00P10 (EXCLUDING HOLIDAY$) <br />I Electronic Information: D List [] Map — Description: 1 1, <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />�HD USEONLY <br />FILES <br />"1 unDmoftOUND TANK (LIST) <br />Street # <br />`street Name <br />City <br />® CON8WIER <br />-_ CLEANUP SITE (LOP) <br />� OTHM CLEANUP SITE (NON -LOP) <br />1 <br />18806 <br />Lower Sacramento Rd <br />Woodbridge <br />hA AKDOUS WASTE <br />L] DNAY <br />® TIEaeD P?P.WITTED FAuurr <br />X <br />18870 <br />Louder Sacramento Rd <br />Woodbridge <br />M ADOVPGFkOUND TANK <br />- <br />501 <br />D'Arcy Parkway <br />Lathrop <br />I] PWS <br />, �+ i <br />UST (MONITORING I REMOVAL) <br />(� HAZARDOUS MATCRIALB <br />SPatJRELEASE RESPONsr <br />[DLddaTER QUALITY <br />❑ SOLID WAST? FACILITY /VEHICLE <br />4 <br />IJ FOOD FACILITY <br />J <br />[SITE MITIDATION <br />l F-1 POOL / EPA <br />IDAIRY <br />5 <br />lJl t <br />Y --3H <br />�J <br />i LAND UsE APPLICATION SITES <br />Houemo <br />I7 SEPTIC PUMPER TRUCK I <br />6 <br />YARD I CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />®/CUPA <br />HOUSING ABATEMENT <br />7 <br />a MOTEL/HOTEL <br />Ca'CUPA. HA7-MAT <br />CHICKEN RANCH I DoG KENNEL <br />Cj MEDICAL WASTE FACILITY <br />B <br />l7 TATTOoi8oDY PIERCING <br />❑ SOLID WAETE <br />® WASTE TIRE <br />§ <br />- <br />COMPLAINT <br />Q ACCOUNT,Na <br />OTHER(PLEASE SPECIFY): <br />I <br />q0 <br />—BOXED AREA - EHD USE ONLY'" <br />I -20f9:3RRnNo0LR kuv�uti �OVTuc21ruit1. Staff Name: <br />1� <br />