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rr& 0212212016 09:30 (FAX) P.0011001 <br /> R.,EQE1VEr" EEtD LOGNUI�181lR <br /> SAN JO.AQ"e. HR COUNTY <br /> FEB 2 2 � ENVIF ONMEN rAL HEALTH DEPARTMENT � <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EWRONMEWALH &Whons': (209)458-3420 Fax: (209) 454-0138 VVeh' wWW_s]gov.arg/ohd ' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Jennifer Beq[klan BUSINESSfAGENCY:Advanced GooEnvironmental <br /> ADDRESS: 637 Shaw Road CITE'/$TATE(ZIP. Stockton,CA 95215 <br /> PHONE (1): 209-467-1009 RHONE 209483-3401 FAX O- E-11.1 AIL. 209-467-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available.. <br /> Staff will contact yDu to arrange an appointment elate and time to review the requested records, <br /> ❑ CHECK SOX TO ED PEDITE EST- Cl{ECIK ONLY)-REW EST Pn6cEssi:o W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ElE�trG+E4IC'1nF . f i LI ne <br /> orma.icn: ;J a.� b SI'1 --w�3%r'Ept:ivt`i: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Streac# Street Name CRY <br /> 42 <br /> 100 South Ventures Stockton 1 aZ fAA9mo i" (�le <br /> 2. 2040 West Washington Stocktonk'To A55- J Unit 9 <br /> 3 1 S0, Wast gain Street Stockton (r � D ,5 nit 2 <br /> 4. I ' <br /> ❑Unit 2H Tn <br /> 5. unit 3 /Q 4 <br /> i <br /> S. <br /> `f nit 3HM <br /> 7. <br /> ❑Unit 4 <br /> 8. <br /> L/GIYI~hlIlTIGgTT0W <br /> 9. <br /> 1 g. II nit 8 <br /> Speclflc Date Range of Information Requested: From _ to <br /> ENViRGNMENTA.L HEKLfH D1=PART'MENT FILE& <br /> ©UNDERGROUND TANK(USI)CLEANUP SITE(LOP) ❑MOTEUHO'IEL ❑SOLID WASTE FAULITYNERCLE <br /> �!C]DTHER CLEANUP SITE(NOtMP) ❑Hozlilw AW1IMFJ ❑FOOD FACILfTY J Co rror 6(j1 <br /> UNDFiZM0UNuTAWK9AOfJITORINWREMOVAL)Y, NVVASTETIRE ®DAIRY,POOLISPA <br /> LA <br /> ABOVEGROUND TANK CHICKEN PA ?J DDG KENNEL ❑WASTEWATER TREATMENT PLAhrr <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILM ❑PUMPER TRUCK YARDIC;HENICAL TOILETS <br /> fl HAZARDOUS MATERIALS ❑TA7ro-0/13ODY PIERCING ❑LAND USE AWCATION SITES <br /> ©TIERED PERMiTTEO FACILITY ❑COMPLAINTIRE5PON5E RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PEWIffRECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAYS:00Am-5:OQPM(EkcWDINGHOLIDAYS) <br /> 1, LbA yi2 tQ tan addresses In the apace above. Select the type(s)of files from the list above by checking the approprlate <br /> box(es). At least one file type MUST be solected. jFax to(208)4B4-0138 or mall to the add= iU�0012�-above., Address <br /> ranges will not be accepted,Applications recelved after 3:00 pin 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 EHL?file°exist An appointmentfor review vent be conflrmed approArnately ten(1i0) <br /> dRys after receipt of application. The flies will be held for a maximum of five busine&s days for review. ,appointment.* <br /> should be scheduled accordingly. <br /> 4. Any file not returned In the Same condition as released vAll be reorganized by EHD stiff at the expense of the eppllcant. <br /> Future Me revleti•8 by the some applicant may require a $130 deposit prior to review. <br /> -BOXED AREA.-EHD USE ONLY" <br /> l f 0 f 5 too- <br /> r wQ n <br /> Records provided by Staff-FPR Complete. staff Name: <br /> Received Time Feb, 22, -2016— 9 : 18AM"No. 0494 - <br />