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12/21/2012 16:12 Advanced GeoEnviromental Inc. (FAX)2094671118 P.001/001 <br /> ATE RECEIVED EHD LOG NUMBER <br /> a�C. <br /> I� V E D SANJOAQUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEL 2 1 201 1868 East Hazelton Avenue, Stockton, CA 95205-6232 .��/J/7 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd / / <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AIIV Colavita et1SINESSIAGENCY: Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/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 /> (Pleaas allow 10 business days from date of application submittal--Tentative,only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU - 125 FE CAS R HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 12-/Z r/r7 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY 000 <br /> Street 9 street Name City Unit 1 (l <br /> t• 18754 East State Route 26 Linden OF <br /> 7- <br /> Unit 2 <br /> S. <br /> 4• time a <br /> S. <br /> S. <br /> Unit 4 <br /> r• I <br /> s. <br /> Unit 6 <br /> 8, <br /> 10. <br /> nit 6 <br /> Specific Data Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT I]SOLID WASTE FACILITYNEHICLE <br /> x❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY Q WASTE TIRE <br /> x❑UNDERGROUND TANK(MONnropaO/REMOVAL) ❑DOG KENNEL M DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> (]TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY E COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PM(EXCLUDTNG HOLIDAYS) <br /> 1. List uo to ten addressee In the apace above. Select the type(a) of Nles 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 mall to the address Indicatod li ove. 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 /> oubmltted 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 some applicant may require a$125 deposit prior to review. <br /> EbID USE ONLY <br /> Received Time Dec. 21. 2012 4: 09PM No. 1952 Smit <br />