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1111012015 15:27 (FAX) P.0011001 <br />it� L EHD LOG NUMBER <br />l� SAN JOAQUIN COUN I <br />TLY EC Y <br />ENVIRONMENTAL HEALTH DEPARTMENT 9911(oNOV R 0 2015 ti 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�tiCK� <br />10 Jfielephone: (209) 458-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENMONMENTAL <br />P��c1TL, �, ,�an—rnr-air PUBLIC RECORC)S RELEASE APPLICATION <br />APPLICANT: Jennifer BerJiklan BUSINESS/AGENCY: Advanced GeoEnvironmental <br />ADDRESS: 837 Shaw Rood <br />CITY/STATE/ZIP: Stockton, CA 95215 <br />PHONE (1): 209-467-1006 PHONE (2): 209-483-3401 FACSIMILE: 209-467-1118 <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 appointment date and time to rsview tho requested records. <br />❑ CHECK BOX TO EXPEDITI= UE - 9130 F (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 USINESS DAYS <br />OCHECKBOXTOIEXPEDITFESIGNATURE OF APPLICAN DATE ��!� 0 <br />Electronic Information: ❑ List Map — Description: <br />I <br />FILE ADDRESS <br />(�" <br />EHU USE ONLY <br />Street # <br />Street Name <br />City <br />1. <br />213 <br />South Kelly <br />Lodi <br />Unit 1 <br />2. 214 <br />South Kelly <br />Lodi <br />3, <br />224 <br />South KellyLodi <br />�� <br />El ti 1 <br />nit 2 <br />4. <br />77 <br />South Cluff <br />Lodi <br />VUnit <br />2H <br />5. <br />851 <br />East Lodi Avenue <br />Lodi <br />L CJQ, <br />UZ ; <br />U/nlt 3 <br />6. <br />7. <br />0 nit4 <br />8. <br />r � rrTc Ngm�^TIO:ti <br />9. <br />GYtlnit 6 <br />10. <br />- - <br />Specific Date Range of Information Requested: From _ to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />F UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTEACILITY��j�,EHICLE / <br />Q OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ARATENIENT WASTE TIRE tN Fl l t' <br />Q UNDERGROUND TANK (MONRORINO/REMOVAL) ;*- ❑ FOOD FACILITY ❑ DAIRY ( i) _ Z-3 -L5 <br />[] ASOVEGROUND TANK ❑ CHICKEN RANCH/ Doc KENNEL MWASTEWATER TREATMENTL 1NT <br />[I HAZARDOUS WASTE] HAZARDOUS MATERIALS.:-' ❑ MOTEL1HOTEL ❑ PurAPER TRUCKIYARDICHEMICALTOILET6 <br />©TIERED PERMITTED FACILITY '' ❑ POOLISPA E1,6ND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING I] COMPLAINTIRESPoNsE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RIEVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses In the space above, Select the types) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be aeiacted. Fax to (208)4664-01338 or mall to the address Indicated above Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For essl stance In Idantlfydng 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 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. <br />Future file reviews by the same applicant may require a $130 deposit prior to review. "'"BOXED AREA - EWD URF ONLY" <br />Z3 5 <br />15 •• G�iY1 � ' � � I � � d7 <br />r <br />❑ Records provided by Staff-PIAR Complete. staff Name: <br />.un sass <br />T111115 <br />