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Ad`MC i�aI:�7�Qp♦t43 To:'2094640138@I<fax.cD Fax: +1 (209)4640138 Page 1 of 1 12/0812016 3:39 PM <br /> DATE.RECEIVEp v �G I■ir// <br /> SAN JOAQEHD LOG NUMBER <br /> DECyt1C UIN .COUNTY <br /> % UEC 0 0 LUIU ENVIRONMENTAL HEALTH DEPARTMENT ^ <br /> • <br /> 1East Hazelton Avenue,Stockton, CA www-sjgov.org/ehd 1 �. • I tE.3iNIftnNtllf3�fTAL HEltt.TH Telephone:: (2(2 09)468-3420 Fax: (209)464-0138 Webb::www-sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Diane Becker BUSINESS1AGENCYAdvanced GeoEnvironmental <br /> ADDRESS: 3335 E. Miraloma Ave.#142 CITYISTATE/ZIP: Anaheim. CA 92806 - <br /> PHONE(1): 800-511-9300 PHONE(2): 714-52970200 FAX OR E-MAIL: dbeckeraadyoeoeOy.Com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to an date and time to review the requested records. <br /> nge an appointy�S <br /> ❑;CHECK BOX TO EXPEDITE REQUEST $139 FEE(CASH OR CHECK ONLY):-REQUESTkOCESSED IN 3 BUSIN�ESSDAYS <br /> SIGNATURE OF APPLICANT \ , _ ..✓� _ _____� DATE <br /> ll .List up to ten addresses in the space below. Select the type(s)of files from the list below 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.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 appointmentfor 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$139 deposit priorto review. <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—fJescription: <br /> " Specific Date Range of Information Requested: From to <br /> ENl(IRffNMENTA '""- - - <br /> ff4TtiEPESRTIvEr: FILE ADDRESS EHD USE ONLY <br /> i,UNDERGROUND TANK(UST) <br /> Street# Street Name city <br /> CLEANUP SITE(LOP) 1 C telJLl1— pCOKnIMER <br /> OTHER CLEANUP SITE.(NDN-LDP) S <br /> 1116 C 1St t .]tOCkt011 \ E_ <br /> HAZARDOUS WASTE ... I <br /> N +J. II <br /> E]TIERED PEeMm[D FACILITY 2 O—Y/Vylr <br /> ❑ADDVCGROUND TANK t L.Yti <br /> �. <br /> UST (MONITORING/REMOVAL) <br /> ❑HAZARDOUS MATERIALS <br /> g SPILI/RaCASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 - <br /> FOOD FACILITY <br /> ❑POOL/SPA Sri[MIrGATIpp. <br /> ❑DAIRY 6 _ <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ HDV^Inc <br /> YARD/CHMICAL TOILETS 6 ' <br /> WASTEWATER TREATMENT PLAN!' <br /> HOUSINGA6ATEMEN7 - r CUPA <br /> MOTEUHOTEL ' <br /> ❑CHICKEN RANCH I DOG KENNEL. . - CUPA-UST <br /> ❑MEDICAL WASTE FACILITY 6 <br /> ❑TATTOO/BODY PIERCING <br /> n WASTE TIRE ❑SPUD WrsTE <br /> COMPLAINT $ <br /> ❑OTHER(PLEASESPECIIY): -- -....... <br /> 'D �A[CWI.TNG <br /> '•'BOXED AREA.EHO USE ONLY"" -- -., <br /> ❑ Records provided by Staff-PPR Complete.staff Name: <br /> EHD 4546 <br /> Received Time Dec. 8. 2016 3: 36P) No. 0475 <br />