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RECEIVE[I. <br /> SAN�JOAQUIIV��ry <br /> r , , ��,8 Environmental Health Department <br /> - ��- -f � <br /> C O U N T Y ,vt-ker aft- PUBLIC RECORDS RELEASE APPLICATION <br /> �^ RQNMEWAL LWAJ <br /> �,Tr Ctn�'S5 CrOs'✓*•'''E ��'/���� <br /> ' /� 1T BY EMAIL Q <br /> lD���l EHD LOG NUMBER: <br /> APPLICANT: Diane Becker BUSINESS/AGENCY:Advanced GeoEnvirronmental <br /> ADDRESS: 837 Shaw Rd. CITY/STATE/ZIP:Stockton,CA95215 <br /> PHONE(1): 800-511-9300 PHONE(2):714-529-0200 FAX OR E-MAIL: dbecker@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 ! 1 DATE 3 <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 infoOsicehd.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. 2 <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 1-1-1940 to 6-13-2018 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS �lh i CD. "f�✓�� <br /> ( p y 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> ❑x Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) UPJ CONSUMER <br /> ❑X Other Cleanup Site(Non-LO 301 E. Lodi Ave. Lodi <br /> X Hazardous Waste !� <br /> El DAIRY <br /> ❑Tiered Permitted Facility 2 <br /> ❑X Aboveground Tank �� t <br /> ❑X UST (Monitoring/Removal) ❑PWS <br /> 0 Hazardous Materials 3 <br /> ❑K Spill/Release Response <br /> ATER DUALITY <br /> ❑x Solid Waste Facility/Vehicle 4 <br /> Food Facility <br /> Pool I Spa SITE MITIGATION <br /> Dairy <br /> 5 <br /> ❑Land Use Application Sites <br /> Septic Pumper Truck/ 6 HOUSING <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant R16UPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch I Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> F-1 Tattoo/Body Piercing <br /> SOLID WASTE <br /> r-1 Waste Tire 9 <br /> ❑Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> 11 pp ***BOXED AREA-EHD USE ONLY*** <br /> (.1n Ve {l e d-vim <br /> 7' l <br /> ❑ Records provided by Staff-PPR Complete. staff Name: EHo48-o6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />