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1110512010 17:22 Advanced GeoEnviromental Inc. <br />�® <br />(FA,K)209 4671118 <br />R p10 SAN JOAQUIN COUNTY <br />NoV 0 g ENVIRONMENTAL HEALTH DEPARTMENT <br />n� 600 East Main St. Stockton, CA 95202-3029 <br />�E�CS'el�ephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br />PQM SE PUBLIC RECORDS RELEASE APPLICATION <br />KIM <br />P.0011001 <br />EHD LOG NUMBER <br />51 -1 (D 3 <br />APPLICANT: Ally Colavita BUSINESSIAGENCY: Advanced GeoEnvironmental <br />ADDRESS: 837 Shaw Road CITY/STATE/ZIP. Stockton, 95215 <br />PHONE (1): 209-467-1006 PHONE (2): 209-483-3401 FACSIMILE: 209.467-1118 <br />TENTATIVE` APPOINTMENT DATE: .45,r E Time: <br />(Please allow 1 D business days from date of application submittal - •Tontatfvo only - must be conflrmed) <br />® CHECK BOX TO EXPEDITE REQUEST- $122 FEE (C OR OECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE tl [S -/t o <br />Electronic Information: ❑ Llst ❑ Map — Descriptlon: <br />FILE ADDRESS <br />EHD USE ONLY <br />_ <br />Street fl <br />Street Name <br />City <br />i• <br />C <br />StLL O I,%US <br />T ZLjo <br />T '5 6 e.; I "" �It <br />D <br />E .k.._ <br />ke 40 Q)aP; nit 3 <br />4• .7 <br />GtLi 'C Vt- <br />" <br />s. q I I <br />(W' ' <br />�'( /_ nit 4 <br />g•3 <br />0 <br />Pa ; c Ave—" <br />7. <br />nit 0 <br />8. <br />9. <br />e <br />10I <br />OW <br />• <br />14 -It <br />Spoclflc Data Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES w <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) © HOUSING ABATEMENT X❑ SOLID WASTE FACILITYIVEHICLE <br />® OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY X❑ WASTE TIRE <br />® UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ® DAIRY <br />® HAZARDOUS WASTE GENERATOR tY ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />® TIERED PERMITTED FACILITY ❑ MOTEL1HOTEL ❑ PUMPER TRUCK/YARDICHEMICAL TOILETS <br />© TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEw: MONDAY -FRIDAY 8:00 AM5:00pm (EXCLUDING HOLIDAYS) <br />1. List uv to ten a4drn*v9s In the *pace obove. $$loot the typo(*) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to f2A9) 464.0138 or mall to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The !HD 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 *ch$dul$d 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 file Is available. <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 $122 deposit prior to review. <br />r,,,, „ate �. <br />ur/cwnu <br />