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SAN JOHN.�CEIVED��i Environmental Health Department <br /> C 0 U N T �. PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRONMENTAL ew,( <br /> PERMIDSERV! I BY EMAIL �-13 ( 'a� 1 <br /> EHD LOG NUMBER. <br /> APPLICANT: Rebecca Natal BUSINESS/AGENCY:Advanced GeoEnvirunmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton,California,95215 <br /> PHONE(1): 209-467-1006 PHONE(2):2',z,623-721;rI FAX OR E-MAIL: Rnatal@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 /> SIGNATURE OF APPLICANT DATE ., I :o <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138, mail to the <br /> address indicated below, or email to info(a)sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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. Z� <br /> Future file reviews by the same applicant may require a $152 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 Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> ❑x Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) AJ 0 U9f CONSUMED <br /> 1931 E Oak St ockton �f� eQ <br /> �X Other Cleanup Site(Non-LOP) �D "tel' <br /> FX_j Waste H�,NW�1 1 r co <br /> P,Y <br /> Q Tiered Permitted Facility 2 1 722 E Flora St Stockton Wn� t y^ �!1��- O <br /> Q Aboveground Tank N 0 <br /> ❑x UST (Monitoring/Removal) • �� AJ0 U 5T El PWS <br /> I� Hazardous Materials 3 1903 E Fremont9l ' o ekto n �„ 1 y f,✓1l�! (�� <br /> Q Spill/Release Response <br /> U <br /> Solid Waste Facility/Vehicle 4 1960 �(l�!1 uL' r- T u i co <br /> F-] FoodFacility E Fremont m o n t S t Stockton IUD <br /> �y <br /> F] Pool/Spa • 1�1{N/i A IO .ILS(( ITE M1Tic.TION <br /> Dairy 5 1908 E F re m o n tockton No c0/o,r kQ <br /> ❑X Land Use Application Sites <br /> Septic Pumper Truck/ we <br /> Yard/Chemical Toilets 2001 E Fremont St Stocktontl <br /> Q Wastewater Treatment Plant HM,t-1r✓i15C tjgT_ OZ311 UPA C <br /> F-1HousingAbatement 7 2010 E Fremont St Stockton y � A 1 HM I HW <br /> ❑ Motel/Hotel NQ C& <br /> Chicken Ranch/Dog Kennel ` (. ©5 Z CUPA <br /> F1 Medical Waste Facility 8 2040 E Fremont St Stockton No a 17104 UST <br /> ❑Tattoo/Body Piercing ❑SOLID WASTE <br /> F]Waste Tire 9 <br /> Fxj Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> fC -kAd 8 - <br /> -P0Z 0 Z5 I tO"7 1'5 com Pd '5 r616 e k'-90� 8.S <br /> s <br /> ❑ Records provided by Staff-PPR Complete. staff Name: - -( ( D48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.corn <br />