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1212412014 10:29 (rax tj.UU I IUU I <br /> ■ EHD LOG NUMBER <br /> i■ DATE RECEIVED SAN JOAQUIN COUNTY <br /> I. RECT DEC 2 4 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 1668 East Hazelton Avenue, Stockton, CA 95205-6232 79155 <br /> Telephone: (209) 466-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> .PUBLIC RECORDS RELEASE APPLICATION <br /> APPI.ICANT:Jennifer Beriikian BUSINESS/AGENCY:Advanced GeoEnvironmental <br /> ADDRESS: 837 North Shaw Road CITY/STATE/ZIP: Stockton, CA <br /> PHONE (1): (209)467-1006 _ PHONE (2):(209)483-3401 FACSIMILE: (209)467-1118 <br /> TENTATIVE"APPOINTMENT DATE: ASAP _ _ Time: _ <br /> (Pleaae allow 10 business days from date of application submittal-'Tentative only-must be conflrmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST�y�t2' EE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS r <br /> SIGNATURE OF APPLICANT' - DATE <br /> Electronic Information: p Llst Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - Unit 1 <br /> 1. -11101 EST RT 4 HWY Stockton -- <br /> 2. 603 Best Road Stockton W PIL A 0 << EI Unit - <br /> 3. 11030 Copperopolis Road Stockton . — &�'et �c( <br /> 4. 999 South Jack Tone RQad Stockton �- �� LD fv� I Unit <br /> 6. 10333 E ST RT 4 HWY Stockton -= <br /> e• 11555 E,.ST RT 4 HWY Stockton S 11.0 4'� [] Unit <br /> 7. mCs �n�� <br /> g, Unit 6 <br /> 70. Unit <br /> Specific Dote Range®f Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> x®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®HOUSING A13ATEMENT SOLID WASTE FACILrTY/1/EHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ®FOOD FACILITY M WASTE TIRE <br /> X®UNDERGROUND TANK(MDNRORING/REMOVAL) ®DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR []CHICI(EN RANCH ®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ®MOTEL/HOTEL PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> TATTOOlUODY PIERCING ®POOL/SPA LAND USE APPLICATION SITES <br /> ® MEDICAL WASTE FACILITY COMPLAINT RECORDS ®OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Llat up to ten addreeees In the apace above. Select the type(®) of flies from the list above 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. Addrasg, <br /> ranges will not be accepted-for addltlonal assistance with file addresses, contact the EHD. Applications received after <br /> 3:00 pm will be proce9ged the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appolntmentfor 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 /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the Ole Is available. <br /> 4. Any the not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file revlewa by the same applicant may require a $125 depo5lt prior to review. <br /> u Y Kn21 1=w p-5 11v-60 Clef ero -d' r <br /> Received Time--Dec, 24,2014-10:22AM--No, 7781 PIS/'1t <br />