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R It ■ : Advanced GeoEnviroiFax: (707) 570-1461 To: Fax: +1 (209) 464-0136 Pag= 1 of 1 04119/2016 3:32 PM DA I gam, SAN JOAQUIN COUNTY EHD LOG NUMBER Sam �i'.'E I■If RpRp FF Ef� vIRONMENTAL 14EALTH DEPARTMENT A PIR 2 0 21016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd `i c F �T HFLTH _ PERM'T/bEWCES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: Jennifer Berjikian BUSINESS/AGENCY: Advanced Geo Environmental ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton, CA 95215 PHONE (1): 209-467-1006 PHONE 209-483-3401 FAX' OR E-MAIL: jberjikian@advgeoenv.com Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK BOX TO EXPEDITE REQUEST 7.$.13.0 F.EE..CASH.9R CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT (�" ` DATE Electronic Information: :1`;;- FILE ADDRESS EHD USE ONLY ENVIRONMENTAL Street # Street Name City 1. 3755 West Lane Stockton C�, j ,J ❑ Unit 1 2. X❑ HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY X❑ HAZARDOUS MATERIALS 3. ❑ TIERED PERMITTED FACILITY ❑ COMPLAINTIRESPONSE RECORDS Unit 2 4. ❑ Unit 2H 5. [Unit 3 f ,j' /� �1;ZCJ 6V% Unit 3HM I.] Unit 4 $ 2/SITE MITIGATI0IN 9. ❑ Unit 5 10. Specific Date Range of Information Requested: From ENVIRONMENTAL HEALTH DEPARTMENT FILES Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOTELIHOTEL ® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT X❑ UNDERGROUND TANK (MONITORINGIR.EMOVAL) ❑ WASTE TIRE X❑ ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL X❑ HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY X❑ HAZARDOUS MATERIALS ❑ TATTOOIBODY PIERCING ❑ TIERED PERMITTED FACILITY ❑ COMPLAINTIRESPONSE RECORDS to ❑ SOLID WASTE FACILITYNEHICLE ❑ FOOD FACILITY ❑ DAIRY, POOLISPA ❑ WASTEWATER TREATMENT PLANT ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $130 deposit prior to review.