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02/05/2016 14:50 (FAX) P.001tool <br /> e <br /> ve <br /> lea RECEIVED <br /> DATE RECEIVED EHD LOG NUMBER <br /> FEB Q 5 2016 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> E 1RONMENTALHEALTH 1668 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PETIT'SE`' [ephone: (209) 468-3420 Fax: (209) 464-0138 VVeb: www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: JenniferBerilklan RIUSINESS/AGENCY:Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road _ CITY/STATEIZIPSto,kton,CA 95215 <br /> PHONE (1): 209-467-1006 PHONE (2): 209.483-3401 FAX OR E-MAIL: 209-457-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an a tment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE DUES 1 FEE(CASH CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Informatlon: ❑ List Map— Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Straet V Stroot Narno City :n <br /> 1• 2420 South California Street Stockton T I 11)'•, 40/15r' <br /> Z. 2422 South California Street Stockton _ + ' t ❑Unit 1 <br /> 3. 2402 -4, South California Street Stockton OL S El Unit 2 ' <br /> 4• ;84'l' South California Street Stockton 1 ❑Unit 211 <br /> 5• EJUnit 3 <br /> 6. E2`Unit 3HM <br /> 7. p"Unit 4 <br /> B. SITE MITIQATION <br /> 9. <br /> 10. <br /> Specific Date Range of information Requested: From to <br /> I`NVIRONIVIENTAL HEALTH DEPARTMENT FILER <br /> ®UNDERGROUND ) ❑TANK(UST)CLEANUP SITE(LOP) MOTEUHOTEL ❑x SOLID WASTE FACILITYNENCLE �� ��4 t <br /> O OTHER CLEANUP SITE(NON-LOP) F-1HOUSINGABATEMEW ❑FOOD FACILITY _1 �J0,1_ Oj- ' <br /> ®UNDERGROUND TANK(I`A0NrTOR)NG/REM0VAL){CA� ©WASTE TIRE ❑DAIRY,POOUSPA <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMEIVT PLANT <br /> ®HA7ARDOUSWASTE(" MEDICAL WASTE FACILITY ❑PUNFERTRUCK/YARD/CHEf4CALTO[LETS <br /> ®HAZARDOUS MATERIALS ❑TATTODIBODY PIERCING ❑LAND USE APPLICATION SITES t= <br /> ❑TIERED PERmrT7ED FACILITY ❑x COMPLAIRRIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPMC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MDNDAY•FPJDAY 8:D0 Ari 5:00PM(EXCLUDING HOUDAYS) <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. 8 or mall to the address Indicated v Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD flies 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 19Y3 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. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. <br /> "'BOXED AREA-EHD U <br /> (4 ,^ I - - .f�� 1n_75 I <br /> S 0 d 0 'S COi <br /> Received Time.EFeb, 5,�X20162 2: 38PN�No. 0446 s4ahNate:" 5 0� r'4� <br /> 4o 1-tw h N_). <br />