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11/0312014 11:40 (FAX) P.0011001 <br /> -: CIATE RECEIVED EHL?LOG NUMBER <br /> )) SAN JOAQUIN COUNTY <br /> AVIRONi11'iENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ele hone: 209 468-3420 Fax: 209464-0138 Web: www.sjgov,orq/ehd J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Jennifer Bedikien BUSINESS/AGENCY:Advanced GeoFnvlronmental <br /> ADDRESS: 837 North Shaw Road CITY/STATE/ZIP: Stockton, CA <br /> PHONE (1): (208)467-1000 PHONE (2):(209)483-340'1_ FACSIMILE: (209)467-1118 <br /> TENTATIVE*APPOINTMENT DATE: ASAp Time: <br /> (Please allow 10 business days from date of application oubmittai-•TcntcHvo only-must be confirmed) <br /> ❑CHECK BOX TO EXP(=DITEQ T-St.2 E H C>R CHECK ONLY)-REQUEST PROCEED IN 3 BU (NESS DAYS <br /> SIGNATURE OF APPLICANT (., DATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> L_ <br /> FILE ADDRESS EHD UCE ONLY <br /> Street# Street Namo city Unit 1 <br /> 1. 1201 Gertrude Avenue Stockon tL <br /> 2. 1203 Gertrude Avenue Stockton -(C't unit 2 <br /> 3, 1275 Gertrude Avenue Stockton <br /> 4. 4343 Fremont Street Stockton I 1 , Unit3 1`, <br /> S. 1133 Shaw Road Stockton <br /> 6, t I I l <br /> Unit 4 <br /> 7. <br /> Unit C <br /> 8. <br /> 10. .� <br /> _ C7_t7nit 8 <br /> 8peclflc Dato Rango of Information Requested: From all - - _.— _ to - - <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> xQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILTIYNEHICLE <br /> QX OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY l]WASTETIRE <br /> UNDERGROUND TANK(MoNrrORINGIRENAVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREAWENT PLANT <br /> ❑TIERED PEWrrTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMCALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPUCA-awl SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COVIPLAINT RECORDS ®OTIC-R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. 14st up to ten addresses In the space above. Select the type(s)of filen from the list above by checking tho appropriate <br /> box(es). At least one file type MUST be selected. Emlo 1209)464-0138 2r mall to the address lad! tad ab yg Addross <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. Tho EHD will noUfy the applicant If any EHD files exist. An P.ppointment for review will Ira confirmed approximately ten(10) <br /> dayu aftor rocuipt of application. The files will be held for a.maximum of five buslnean dayu for rsview. Appointmonts <br /> should be uchcdulod accordingly. <br /> 3. A file that la cctlwly being worlmd on by EHD staff mey not bo immodiatoly avaPabl0 for revlew. A new appllcztlon rn y u:t <br /> nubmittcd vrhen file filo lc available. <br /> Any I:ie not returned In the came condition De rlloaaM will be roorg«nlx:d by EHD staff a(thr)-,:pan:a og t713 rppllcant. <br /> Futt:rw Wn rcvrom. by Tho 1sme applicant may raquiru V.$126 deponit prior to ruvlcw. <br /> EHD USE OV.v <br /> Al:rt <br /> Reeeikled I ime No,,, 3. 2014 11 : 22AiM Flo. 7461 <br />