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DATE RECEIVED • `+ =1=4 <br /> tIGUNTY • EHD LOG NUMBER <br /> RECEIVED <br /> EIV ENVIRt�IIAUEElk T4 DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 J <br /> I S 0 2011 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> FrIlMITIS F!'AIDES <br /> APPLICANT: Ally CDlaVita BUSINESS/AGENCY: Advanced GeoEnvlronmental <br /> ADDRESS: 837 Shaw Road CITYISTATE/ZIP: Stockton/CA/95215 <br /> PHONE (1): 209-467-1006 PHONE(2): 209-483-3401 FACSIMILE: 209-467-1118 <br /> TENTATIVE*APPOINTMENT DATE: ASAP Time: <br /> �/ (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> Ll' CHECK BOX TO EXPEDITE REQUEST�--$122 FEE(?Sy OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ES <br /> SIGNATURE OF APPLICANT (tet iL —It DATE 5- 30 -11 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 3535 Gtttwkee Rd 3� S [1t�Pyl <br /> 2. 3625 " nitz <br /> 3. 3035 <br /> 4. 5(,55 . _ nit 1 611 <br /> S. 3 &&1 <br /> 8• G(,5 Unit_a_ <br /> T• ADO Ivew4v RtI <br /> 8. 3 300 '' f ❑Unit 5 <br /> 9. 3y3-I- t <br /> 10. unit 6 <br /> Specific Date Range of Information Requested: From All to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> []HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMS:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files 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 mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <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$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 48-06 07/29110 <br />