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DATE RECEIVED r r./'1 ?t`SAN.IOAQUIN COUNTY <br />F () ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EHD LOG NUMBER <br />. tj & <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Rebecca Natal BUSINESS/AGENCY: Advanced GeoEnvironmental, Inc. <br />ADDRESS: 837 Shaw Road CITYISTATEIZIP: Stockton, CA 95215 <br />PHONE (1): 209467-1006 PHONE (2):209-623-7200 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 review the requested records. <br />❑ CHECK BOX TO EXPEDITE RET,- $130 ( OR CHECK$>c,ILY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT r Yl r/�/��J/ DATE ty• �• %� <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />END USE ONLY <br />Q Unit 1 <br />Street # <br />Street Name <br />City <br />1. <br />241 <br />N San Joaquin St <br />Stockton <br />kyt -Ja 47 <br />❑ Unite <br />2. <br />220 <br />N San Joaquin St <br />Stockton . <br />3. <br />p <br />C]Unit <br />q <br />n SITE MITIGATION <br />7. <br />i <br />❑ Unit 5 <br />8, <br />9. <br />❑ Unit 6 <br />10. <br />. Specific Date Range of Information Requested: From All to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILRYNEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />Q UNDERGROUND TANK (MONfrORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />❑ ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AW6:0OPM (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above 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 $125 deposit prior to review. '**BOXED AREA - EHD USE ONLY' <br />P(V,'AekUo(�tF�1X i o c0 M rda.(. <br />C a ' a 1&3 �S iA -({Q 212 S S S Q.. <br />❑ Records provided by Staff -PPR Complete. Staff Name: . <br />Sn Ifl5 <br />