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0pp8pp�/11612017 gppg�w12:29 (PAX) P.002/002 <br /> CRELCE I VE EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG � 6 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 05205-6232 <br /> • <br /> VWRQNMXWALt AI l'ki Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.rjgov.org/ehd <br /> PEmmUTISemble9 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rebecca Natal BUSINESSIAGENCY: Advanced GeoEnvironmental, Inc. <br /> ADDRESS: 837 Shaw Road CITYISTATE/ZIP: Stockton CA 95215 <br /> PHONE(1): 209-467-1006 PHONE (2):209-623-7200 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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-3139E(CASH O HECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 08/16/2017 <br /> 1. List up to ten addresses in the space below. Select the ry e(e les from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209) 4.0138 or mall 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 atter 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 END staff at the expense of the applicant, <br /> Future file reviews by the same applicant may require a $139 deposit prior to review. 0'2 <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 I <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ❑x UNDERGROUND TANK(UST) street N Street Name Clty <br /> CLEANUP SITE(LOP) 0 CONRURER <br /> ❑x OTHER CLEANUP SITE(NOR-LOP) <br /> ' 1011 North Broadway Ave Stockton <br /> ❑HAZARDOUS WASTE 0 DAIRY <br /> ❑TIERED PERMITTED FACILITY ] 916 North Broadway Ave Stockton <br /> ❑AuOveoR00ND TANK <br /> ©UST (MONITORING/REMOVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS S <br /> ®SPILURELEASE R0FON3E WATER eualtt <br /> ❑SOLID WASTE FACILITY/VEHICLE C <br /> ❑FOOD FACILITY / <br /> ❑PDOL/SPA SITE MInDAnoN <br /> DAIRY S <br /> ❑LAND USE APPLICATION SITES <br /> HOUP1No <br /> ❑SEPTIC PUMPER TRUCK/ <br /> e <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEYIATERTREATMENT PUNT ©/CUPA <br /> ❑HWSINGASATEMENT T <br /> MOTWHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-VST <br /> ❑MEDICAL WASTE FACILITY e <br /> ❑TATTOO/BODY PIERCING 13 SOLID WASTE <br /> ❑WASTE TIRE <br /> D <br /> ❑COMPLAINT <br /> Irl OTHERIPLEASE SPECIPY): ❑ACWONTN6 <br /> 10 <br /> '^BOXED AREA•EHD USE ONLY"' <br /> n n <br /> GC n7 '�T, / , }�;;•'Y .t tom,li ^t , . .:� r.< S <br /> — T <br /> ReceevedaTYme�i�Au �Y6. —t2017T11 :IN9AM—No,,12109 <br />