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s®� 02/0512016 14:50 (FAX) P.0011001 <br /> C II <br /> RECEIVED <br /> 0 <br /> DATE RECEIVEDEHD LOG NUMBER <br /> • <br /> FEB Q 5 2016 SAN J17AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 1868 East Hazelton Avenue, <br /> 950 <br /> , Stockton, CA 95205.8232 <br /> PERMI`rrStephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berjiklan BUSINESS/AGENCY:Advanced GeoEnvironmental <br /> 837 Shaw Road CITY/5TATErZIPStockton,CA 95215 <br /> ADDRESS: 209- -3401 209.467-1119 <br /> PHONE (1): 209 487-1006 PHONE (2): 493 FAX OR E-MAIL: <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 a tment date and time to review the requested records. <br /> [] CHECK BOX TO EXPEDITE IREQUE S1 FEE(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE rL <br /> Electronic Information: ❑ List C Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> F7. <br /> Street Mama city <br /> South California Street Stomion ❑Unit 1 <br /> South Celifornla Street Stockton <br /> Stockton ❑Unit 2 91(0 <br /> South CaliforniaCelifornla Street ` <br /> South California Street Stockton ❑Unit 2H <br /> . Unit 9 <br /> Ig Unit 3HM <br /> O'Unit 4 <br /> B ''SITE MITIGATION <br /> 9. D nit6 <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> to <br /> IEt1VIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MOTELIHOTEL <br /> ❑FOODFASTE ACILfiYNEWCLE <br /> ❑x HONE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD POOIISPA <br /> UNDERGROUND TANK(MONROimNGIREMOVAy ®CHICKENIRRANCW DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®ABOVEGROUNDTANK MEDICAL WASTE FACILITY C3PUNPERTRUCKIYARDICHEMCAL TOILETS <br /> ®HAZARDOUS WASTE LAND USE APPLICATION SITES <br /> ®HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑ <br /> ❑TIERED PERMTITEO FACILITY ❑x COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFI') <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00Aht-S:OOPM(EXCLUDINGHOUDAYS) <br /> 1, I - r,i^to ten addresses In the apace above. Select the typs(s)of flies from the list above by checking the appropriate <br /> box(ea). AL least one file type MUST be selected. '^41454 0138 or mail to the address Indicated above Address <br /> ranges will not ba accepted•ApplfcaUons received after 3:00 pm will be processed the next bualness day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contacf EHD at the number noted above. <br /> 3. The EHD will notify the applicant lF any EHD Flies exist An appointment for rev ew will be confirmed approximately ton(10) <br /> days atter receipt of application. The files will be held for a maximum of flys business days for review. Appointments <br /> should be scheduled accordingly. <br /> e expanse of the applicant. <br /> 4. Any file not returned In the same condition es released will ba reorganized by EHD sffiff et th <br /> • Future file review_s by the same applicant may require a deposit prior Lo review. <br /> "'BOXED AREA <br /> -EHD USE ONLY"' <br /> s'�n�'ma: <br /> Received TImekeb. 5, X24162-2^36PNEMo, 0446 <br />