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RECEIVED <br />SANIIOAQUIN MAR 29 20i, Environmental Health Department <br />--COUNTY— PUBLIC RECORDS RELEASE APPLICATION <br />Gr¢e Mess 9,Ui%s hcENVtROflQtll�jl[� MAIL WJJ•','•1" <br />� j;4D EHD LOG NUMBER: <br />APPLICANT: Jackie Hyman BUSINESS/AGENCY:Advanced GeoEnvironmental <br />ADDRESS: 3335 East Miraloma Avenue #142 CITY/STATE/ZIP: Anaheim, CA 92696 <br />PHONE (1): 800-511-9300 PHONE (2): FAX OR E-MAIL: iaahyman@gmail.com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contactyou to arrange an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT Q —r DATE 28 March 2018 <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 inforaDsicehd.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. -) p <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 />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />FILE ADDRESS <br />only, address ranges will not <br />be acceptetl�� <br />EHD USE ONLY <br />❑x Underground Tank (UST) <br />Street# <br />Street Name <br />City 411 <br />1 <br />7 <br />West Oak Street <br />Lodit <br />E] CONSUMER <br />Cleanup Site (LOP) <br />Q Other Cleanup Site (Non -LOP) <br />Q Hazardous Waste <br />XJ Tiered Permitted Facility <br />2 <br />28 <br />South Sacramento Street <br />Lodi <br />❑ Daay <br />Q Aboveground Tank <br />' <br />50 <br />South Sacramento Street <br />Lodi <br />❑PWS <br />Q UST (Monitoring / Removal) <br />Q Hazardous Materials <br />Q Spill /Release Response <br />*` <br />4 <br />N(WATEn DDFInY <br />Solid Waste Facility / Vehicle <br />❑ Food Facility <br />rtE MrtKvno6 <br />❑ Pool / Spa <br />❑ Dairy <br />Q Land Use Application Sites <br />6 <br />t <br />I ,� '(l <br />(/v ( <br />� <br />_Ike— <br />❑ HOUSING <br />yq <br />Septic Pumper Truck 16 <br />Yard / Chemical Toilets%W <br />❑ Wastewater Treatment Plant <br />Housing Abatement <br />Motel/Hotel <br />7 <br />f —7 Vj �� <br />1 <br />�� <br />/ CUPA <br />O 1 AST I HM I HW <br />` –lf'_ <br />CUPA <br />❑ Chicken Ranch I Dog Kennel <br />❑ Medical Waste Facility <br />a <br />UST <br />❑ Tattoo/Body Piercing <br />❑ Waste Tre <br />a <br />0 <br />f` v I <br />r V <br />I ❑ SouD WASTE <br />Q Complaint <br />E] Other (Please Specify): <br />10 <br />Aewenntac <br />***BOXED AREA - EHD USE ONLY*** <br />n - !+' e. <br />❑ Records provided by Staff -PPR Complete. Stan Name: BHD 4A m <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />