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RECE <br />SAN 10AQ U I N'V�P, <br />r Health Department <br />COUNTY------- MAY 15 2018 PUBLIC RECORDS RELEASE APPLICATION <br />IIEWRO�IL � <br />PBIN . EHD LOG NUMBER. <br />APPLICANT: Jackie Hyman <br />ADDRESS: 3335 E. Miraloma Ave. #142 <br />BUSINESS/AGENCY: Advanced GeoEnvironmental <br />CITY/STATE/ZIP: Anaheim, CA 92806 <br />PHONE (1): 800-511-9300 PHONE (2): FAX OR E-MAIL: jhymanr>advgeoenv.com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contactu arrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT DATE <br />1. List up to ten addresses in the(Oaci 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 info(cDslcehd.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 staff at the expense of the applicant. 0�3 <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 <br />FILE ADDRESS <br />-1 1 <br />-10 <br />�- c�'' ' <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />only, address ranges will not be accepted) <br />t <br />EHD USE ON Y <br />X❑ Underground Tank (UST) <br />Street # <br />Street Name City <br />Cleanup Site (LOP) <br />1 <br />13402 <br />North Thorto Lod 1 <br />nG 08 no CO SP ❑ CONSUMER <br />XJ Other Cleanup Site (Non -LOP) <br />qid <br />FXJ Hazardous Waste <br />f' <br />'j. t .tiler rlW <br />/�_ �/�� T <br />rh, l-t'tl V As ❑DAIRY <br />11 ' <br />XI Tiered Permitted Facility <br />2 <br />13436 <br />North Thorton Road Lod i <br />0 Aboveground Tank <br />3 <br />5080 <br />West Kingdo*,Lodi <br />❑ PWS <br />X❑ UST (Monitoring / Removal) ( <br />X Hazardous Materials <br />❑ <br />�A <br />,f <br />(IO <br />Q Spill / Release Response <br />4 <br />5279 <br />West Kingdo Lodi <br />ATER QUALITY <br />❑ Solid Waste Facility / Vehicle <br />❑ Food Facility <br />, <br />no 1>� no eo s <br />5 <br />5285 <br />FSITE <br />o Lod <br />West Kingdo rill <br />MITIGATION <br />❑ Pool / Spa <br />❑ Dairy <br />F—]LandUse Application Sites <br />n� �� n� colsp <br />6 <br />4895 <br />West Kingdon Lodi <br />❑ HouslNc <br />F—] Septic Pumper Truck / <br />Yard / Chemical Toilets <br />n <br />❑ Wastewater Treatment Plant <br />COPA <br />❑ Housing Abatement <br />T <br />AST / HM / HW <br />❑ Motel/Hotel <br />COPA <br />❑ Chicken Ranch / Dog Kennel <br />F—]Medical Waste Facility <br />8 <br />UST <br />❑ Tattoo/Body Piercing <br />❑ SOLID WASTE <br />❑ Waste Tire <br />9 <br />❑ Complaint <br />❑ AccouNTING <br />❑ Other (Please Specify): <br />10 <br />***BOXED AREA - EHD USE ONLY*** <br />r'Y \ 9 t �e�-.�� a rit I l'�Cv/: .t� u�G ° 6� L T <br />J 6 <br />tv 2 1� — F� 1 CD <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 48-06 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209464-0138 1 www.sjcelid.com <br />