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� � �o,carcv i O I G.4� (FAX) P.001l001 <br />s <br />S � <br />DATE RECEIVED -p EHD LOO NUNHER SAN ti0AC1UIN COUNTY <br />RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />SEP 2 f20 15 Telephone. (209) 468-3420 Fax: (209) 464-0138 Web, www.sjgov.org/ehd <br />ENVIRONMENTALH<*ALTH PUBLIC RECORDS RELEASE APPLICAT[ON <br />PERMIT/SERVIULki <br />APPLICANT; JenniferBerjikian BUSINESS/AGENCY'RdvanwdGeoEnvironmental <br />ADDRESS: 837 Show Road <br />CITY/STATE/ZIP; Stockton. CA 85215 <br />PHONE (1): 2(19-667-1006 PHONE (2): 209-483-3401 FACSIMILE: 209-467-1118 <br />Please allow 40 business days from date of application submittal For the records to be available. <br />Staff will contact you to arrange napp 'ntment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDI $130 FEE OR CHECK ONLY) - REOUEST PROCESSED IN 3 BUSINESS I,— <br />SIGNATURE <br />SIGNATURE OF APPLIC T j"- DATE. <br />Electron lc Information: ❑ L s Map - CY ilon: <br />FILE ADDRESS <br />n�HJq g EDNEY <br />J ej Jf 9 i IC (n o <br />Street tF Street Name <br />CIh <br />1. <br />r)yr1 <br />Ia-}-1� Unit <br />2. <br />3. <br />1400 <br />Victor Road <br />Lodi69S <br />Ham( 1 <br />4, <br />1220 <br />East Victor Road <br />Lodi <br />b0 <br />Unit 2H <br />5. <br />1301 <br />EastLockford <br />Lodi <br />S'tf '^" {o,L4",L`r Jt(A <br />6. <br />400 North Cluff <br />Lodi <br />7. <br />0 nit4 <br />8• <br />SITE MITIGATION <br />e. <br />❑ Unit 5 <br />10. <br />SpeolFlo Date Range of Information Requested: From <br />u UNDERGROUND TANK (UST) CLEANUP S17E (LOP) <br />® OTHER CLEANUP SITE (NON -LOP) <br />® UNDERGROUNDTANK(MONRDRING/REMOVAL) <br />❑ ABOVEGROUND TANK <br />❑ HAZARDOUS WASTEIHA2ARDOUS MATERIALS <br />❑ Timrr, PERMITTED FACILITY <br />❑ TATTOG/BOOY PIERCING <br />LJ MEDICAL WASTE FACILITY <br />❑ HOU614u ABATEMENT <br />❑ FOOD FACILITY <br />❑ CHICKEN RANCH! D03 KENNEL <br />❑ MOTELIHOTEL <br />❑ POOL/SPA <br />❑ COMPLAINT/RESPONSE RECORDS <br />to <br />❑ SOLID WASTE FACILrrY/YEHICLE <br />❑ WASTE TIRE <br />❑ DAIRY <br />❑ WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCK/YARDICHEMICAL TOILETS <br />❑ LAND USE AFPUCATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY -FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br />1. List up to ten addresses In the space above. Select the type(s) of flies 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 mall tom 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 flies exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application, The flies 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 reo aanized by EHD staff at the expense of the applicant- <br />Future <br />pplicantFuture file reviews by the same applicant may require a $130 deposit prior to review. "'BOXED AREA - EHD USE ONLY" <br />$ U-c�-, 12� rt {..sr 1+100 �%,Li®rQ t v I-xlrtar3. S -F A LksOuk A.+e. �roJs9e,� <br />Rd LacLW 1400 Victi A000RX-j i v Lb 44P LAONAVv2.c0 <br />10 <br />I ed 5106 .rt lar I t+Yt n 4913 C!J l 2?. L o 299 un -7,z(;. <br />❑ Records provided by Staff -PPR Complete. staff Name: <br />END 48-06 Tittle <br />Received Time Sep. 23. 2015( 3:42PM—No. 9632 <br />