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0113012013 10:13 Advanced GeoEnviromental Inc. <br />I <br />)209 4671118 P.0011001 <br />� DATE RECEIVED EHD LOG NUMBER <br />tic <br />SAN .10AQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Ar <br />.4 IN 3 0 Z013 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PsQ';'iTISE V!CES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Rebecca Natal BUSINESS/AGENCY: Advanced Geo Environmental <br />ADDRESS: 837 Shaw Road CITYISTATE/ZIP: Stockton / CA / 95215 <br />PHONE (1): 209-487-1006 PHONE (2): 209-623-7200 FACSIMILE; -209-467-1118 <br />TENTATIVE* APPOINTMENT DATE: ASAP Time: <br />(Please allow 10 business days from data of application submittal-''%ntative only --must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQ E3 - $1 OR EC LY) - REQUEST PROCESSED IN 3 USINE S DAYS <br />SIGNATURE OF APPLICANT ( DATE�30 1 113 <br />T <br />Electronic Information: ❑ List ❑ Map - Descrlptlo : <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street # street Name <br />City <br />1. <br />171 Unit 2 <br />2. <br />3. <br />Unit 3- <br />4° <br />6. <br />171 UnI14 <br />7. <br />Unit 6 <br />8. <br />9. <br />171 Un1t0 <br />10. <br />Specific Date Range of Information Requested: From all to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />x❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />E] UNDERGROUND TANK (MONITORING/REMOVAL) ❑ Doo KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />x❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCKNARD/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY Q COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RI_CORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5'00FM (EXCLUDING HOLIDAYS) <br />1. List up to ten addressee In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(ea). At least one file type MUST be 0elacted. Fax to (209) 464-0130 or mail to the address Indicated above. Address <br />ranges will not be accepted - for additlonal assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be conflrmsd 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 baling 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 releAead will be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />EHD U&E <br />2HD 48-08 <br />Received Time Jan.30. 2013 10:08AM No -2185 <br />