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RECEIVED <br /> SAN J OA Q U I N Environmental Health Department <br /> C I'D U N��� <br /> ''' �` PUBLIC RECORDS RELEASE APPLICATION <br /> _ �fa <br /> �• MAIL <br /> PEi@tVSIIP/'tS EHD LOG NUMBER: 9 <br /> APPLICANT: Rebecca Natal BUSINESS/AGENCY:Advanced GeoEnvironmental,Inc <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton,CA 95215 <br /> PHONE(1): 209-467-1006 PHONE(2):209-467-111 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 u.. DATE i­�o,ji> <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. <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 1, <br /> HEALTH DEPARTMENT (Specific y 9 accepted) EHD USE ONLY <br /> FILES S fic addresses only,address ranges will not be acce ted <br /> rX Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) a5f, ❑CONSUMER co <br /> Q 16888 S McKinley Lathrop Other Cleanup Site(Non-LOP) <br /> ❑Hazardous Waste N ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> ❑Aboveground Tank Ll✓ ll,_A Kst )�✓ "� <br /> FX UST (Monitoring/Removal) ❑PWS <br /> F]Hazardous Materials 3 <br /> FX Spill/Release Response <br /> F]Solid Waste Facility/Vehicle 4 [O WATER QUALITY <br /> F]Food Facility <br /> Pool/Spa d SITE MITIGATION <br /> Dairy 5 <br /> F]Land Use Application Sites <br /> HOUSING <br /> Septic Pumper Truck/ 5 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant N]'�UPA <br /> ❑ Housing Abatement 7 AST/HM/HW <br /> ❑ Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel ©CUPA <br /> 8 <br /> ❑ Medical Waste Facility UST <br /> ❑Tattoo/Body Piercing ❑SOLID WASTE <br /> F]Waste Tire 9 <br /> F]Complaint <br /> F]Other(Please Specify): E]ACCOUNTING <br /> to <br /> ***BOXED AREA-EHD USE ONLY*** <br /> II <br /> Ift <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />