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■� 01120/2015 11:03 (FAX) P.0011001 <br /> ■ <br /> ■� DATE REC � EHO LOG NUMBER <br /> ■ <br /> SAN aIOAQUIN COUNTY <br /> Q � ENVIRONMENTAL HEALTH DEPARTMENT <br /> :0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> one: (209) 468-3420 Fax: (209)464-0138 Web., www.sjgov.org/ehd O <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rebecca Natal BUSINESS/AGENcY: Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton/CA/95215 <br /> PHONE (1): 209-467-1006 PHONE(2):209-623-7200 FACSIMILE: 209-467-1118 <br /> TENTAT/VE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal••Tentetive only-must he confirmed) <br /> ❑ CHECK BOX TO EXPEDITER E T•$125 FEE( C CK LY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1/20/2015 <br /> Electronic Information: ❑ Llst❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street street Name qty21/ <br /> Unit1 <br /> �� 1• 3808 West Lane Stockton N - <br /> �tyt J 2• 4040 West Lane Stockton m {W AP ST Ns <br /> / 3• 4f)-,. Enterprise Street Stockton Lkg-t 1• <br /> 4, <br /> UnIt3 <br /> 5. <br /> 6. pwiaf'A Irl'ctte �.Cf) id Unit4 <br /> El <br /> B. <br /> Unit <br /> 9. <br /> 10. 16nit 6 <br /> Specific Date Ranee of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> x❑UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑x SOUDWASTE FACIUTYIVEHICLE <br /> lDTHERCLEANUP SnE(NON•LOP) El FOOD FACILITY ❑x WASTETIRE <br /> Q UNDERGROUND TANK(MONITORING/REMOVAL) El DOG KENNEL M DAIRY <br /> x❑HAZARDOUS WASTE GENERATOR ❑CHICKENRANCH ❑WASTENATERTREATMENT PLANT <br /> l]TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPERTRUCFJYARD/CHEMCALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑PDOUSPA Q LAND USEAPPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑D COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW:- MONDAY-FRIDAY 8:00 AM•S:DOPM(EXCLUDING HOLIDAYS) <br /> 1• Ust un to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(2091464-0136 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 H any EHD files exlat 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 filo 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$125 deposit prior to rovlew. <br /> EHD use ONLY <br /> I)rjvlkk LID wXLA Pig File for 11HG En rise w J. LOA ¢ A X19 dot L(oY u '&SiLH. <br /> L 10 17 IAL'r f It icer 40tOcs} Lw <br /> Co G`il1 i Lki.;g File 4 2, (.9f Lt0Whc <br /> J c-t L.LAQ, <br /> EHa� .OB el1l/1 <br /> Received Time Jan. 20. 2015 10 :54AM No- 7929 <br />