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SNN J0AQ k) 0 2018 Environmental Health Department <br /> C, U N T Y- '- PUBLIC RECORDS RELEASE APPLICATION <br /> E�t1/IRQPAIhEN�AL� <br /> • SUBMIT BY EMAIL1 Y7 <br /> EHD LOG NUMBER: TjL/ 1/ <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):'un i��"'/20(1 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 DATE <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)slcehd.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 <br /> HEALTH DEPARTMENT ( p y g accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> 0 Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) 1943 East Fremont St Stockton �� Tv <br /> CONSUMER <br /> XQ Other Cleanup Site(Non-LOP) 1 W 0X15q <br /> • X❑Hazardous Wastet{� ❑DAIRY <br /> r <br /> X❑Tiered Permitted Facility z 1850 East Oak St Stockton <br /> XQ Aboveground Tank <br /> Q UST (Monitoring/Removal) ❑PWS <br /> QHazardous Materials 3 1924 East Park St Stockton <br /> Q Spill/Release Response <br /> ATER QUALITY <br /> F1 Solid Waste Facility/Vehicle 4 <br /> Food Facility v N� <br /> Pool/Spa SITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> ❑HOUSING <br /> Septic Pumper Truck/ 5 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant YC'—'"'PA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> CUPA <br /> Chicken Ranch/Dog Kennel <br /> g UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> waste Tire e <br /> X❑Complaint <br /> ❑Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY <br /> ice- �... (�. `n�,v11e t:V� t•B *V� '`t'�e i+Z- L G � � � ( <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHDaa-os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />