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M :H va d ti eF ralY 5J 1 1 ID: I-ax: ( ]LUy 464-D13S Page 1 ot 1 1 VUW;;U1/5:15 PM <br /> ■D � <br /> SAN ,IQAQUIN COUNTY EHD LOG NUMBER <br /> ERE■■< 4._ ,3 ENVIRONMENTAL HEALTH DEPARTMENT <br /> t♦� t � � 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENV1R0N16W,,AL HEALTH PUBLIC RECORDS RELEASE APPLICATION (a74W <br /> APPLICANT: Jackie Hyman BUSINESSIAGENCY:Advanced GeoEnvlronmental, Inc. <br /> ADDRESS: 837 Shaw Road CITY/STATEIZIP: Stockton, Californ1a 95215 <br /> PHONE(1): 800-511-9300 PHONE(2): FAX OR E-MAIL: jhyman@advgeoenv.com <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 review the requested records. <br /> © CHECK BOX TO EXPEnITr_ pr(lI]EST-$139 FEE(CASH OR CHECK ONLY)- REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 11/02/2017 <br /> 1. List up to ten addresses in the space below. Select the type(s)of flies from the list below 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. 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 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 $139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Informati-on: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> IJ UNDERGROUND TANK(UST) Street Street Name City <br /> CLEANUP SITE(LOP) CONSUMER <br /> 1718 Mariposa Road Stockton 1\VVVI�rj{l <br /> IX1 CTHER 2 CLEANUP SITE(N ON-L OP] <br /> iJ HAZARDOUS WASTE Q � ❑DAIRY <br /> I1 <br /> TIERED PERMITTED FACILITY 1748 Mariposa Road Stockton <br /> F)< ABOVEGROUND TANK C <br /> FUST (MONITORING/REMOVAL ElPWS <br /> HAZARDOUS MATERIALS <br /> 3 1754 Mariposa Road Stockton <br /> a 8PL LIRELEASE RE 5P0N5E " <br /> WATER QUALITY <br /> FXJ SOLID WA57E FAC ILITYI VEHICLE 4 1 796 Mariposa Road Stockton <br /> FOOD FACILITY <br /> ®POCL/SPA SITE MITIGATICH <br /> LJ DAIRY 5 <br /> IX LAND USE APPLICATION SITES - <br /> U61NG <br /> S EPTIC PUMPER TRUCK/ - []Ho <br /> F] <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANTCe.U�PA <br /> E]H OU5ING AKATEMENT 7 A /t <br /> I7 M OTELIH OTEL 1km/iv� <br /> i. CHICKEN RANCH/DOG KENNEL CUPA,UST <br /> MEDICAL WA57E FACILITY 8 <br /> TATTOO/BODY PIERCING <br /> S OLID VUA6TE <br /> IXj WASTE TIRE 9 <br /> P COMPLAINT <br /> 0 THER(P LEASE SPECIFY): ❑AcOOUNTING <br /> 1D <br /> —BOXED AREA•EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Tine—Nov, 2. 7017 5. 10PITNo, 2517 <br />