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aulll pan I aOa� <br /> 609L 'ON &. , l l 1? OZ '�Z '^ON <br /> DATE RECEIVED EHD LOG NUMBER <br /> REqq�� (`� E' / SAN .JOAQUIN COUNTY <br /> IGy E:U ENVIRONMENTAL HEALTH DEPARTMENT gov <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NOV 2 4 2014 Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> PE RNA VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Diane Becker BUSINESS/AGENCY: Advanced Geo Environmental <br /> ADDRESS: 3335 E. Miraloma Ave., Suite 142 CITYISTATE/ZIP: Anaheim / CA/ 92806 <br /> PHONE (1): 714-529-0200 PHONE(2): 714-746-4947 FACSIMILE: 714-529-0203 <br /> TENTATIVE*APPOINTMENT DATE: - Time: <br /> (Please allow 10 business days fro dfate of appli ca i n submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST $ 254E(CASH C ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /J _2Lf j y <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> ©'Unit 1 <br /> 7G r-t <br /> 2. i�j�\ �E!-U--r it 2 I i <br /> 3. ' <br /> 4. [ lnit 3 <br /> 5. <br /> 6. (/( 4nit 4 <br /> 7. <br /> 8. <br /> El Unit 5 <br /> 9. <br /> 10. E7 Unit 6 <br /> Specific Date Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL x❑DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPAx❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY FX1 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. Fax to(209)464-0138 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 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 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 review. <br /> ■ <br /> ■ <br /> EHD as-os <br /> a11/11 :■ <br /> ■ <br /> o�•i t,in�+.,�n1 10 1 a6ea or i_ntatFnn.+ :xea uorxe»W,�)ac intatan7:01 istL-as(lN):Xealol1AUri0aq De3UeAPH N=M <br />