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■ 10124/2014 08:22 (FAX) P.0011001 <br /> ■ <br /> I ■ <br /> ■ <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ■ G ENVIRQNMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov,org/ehd <br /> PERTOXISEVI PUBLIC RECORDS RELEASE APPLICATION t <br /> APPLICANT:Jennifer Berjikian 13USINESSIAGENCY:Advanced GeoEnviron mental <br /> ADDRESS: 837 North Shaw Road CITY/STATE/ZIP: Stockton, CA <br /> PHONE(1): (209)467-1006 PHONE(2):(209)483-3401 FACSIMILI=: (209)467-1118 <br /> TENTATIVE'APPOINTMENT DATE: ASAp Time: <br /> (Please allow 10 business days from date of application submittal-`T'Pnf&fly@ only-must be co rme ) <br /> ❑ CHECK BOX TO EXPEDITE QU X125 FEE OR CHECK ONLY)-REQUEST PROCESSED IN1�17nY[SIGNATURE OF APPLIC � DATE <br /> Electronic information: Map—Description: <br /> FILE ADDRESS ��EHDUSE ONLY <br /> Street 9 Street Name City LV - Unit 1 <br /> 1. 3400 Newton Road Stockton — v <br /> 2. 3516 Newton Road k Stockton 0 Unit <br /> 3. 3535 Cherokee Road Stockton <br /> f <br /> 4. 3655 East Cherokee Road Stockton —I I C^C� �� unit3 I j <br /> 6. <br /> 6. E"Untt 4 <br /> 7. <br /> 8. Unit 5 <br /> 10- 1. 0 Unit e <br /> Specific Date Range of Information Requested: From all to r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> x❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0SOLID WASTE FACIL[TYNEHICLE J <br /> x]OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY X❑�WASTE TIRE <br /> 0 UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNEL L_J DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEVVATERTREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRLICK/YARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> L1 MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. rax to(2091464-0138 or mail to the addre$s indicated above. Address <br /> ranges will not be accepted-for nddltlonal 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 /> submitted when the file Is available. <br /> 4. Any file not retumed 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$126 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 4" X11 <br /> Received Time Oct. 24, 2014 8: 04AM No. 7401 <br />