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IW0212015 17:08 (FAX) P.0011001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY at <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> OCT 0 5 2015 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> Et ApREQAr�,qA4r,,,Tel HFAITH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLTC�NTRVJSA1i%r Ber)Iklan BU SIN ESS/AG ENCY-Advanced GeoEnvironmental <br /> ADDRESS: 837 Show Road CITY/STATE/ZIP:Stockton,CA 95215 <br /> PHONE(1): 209-067-1006 PHONE (2):209-483-3401 FACSIMILE:209-467-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List ❑ Map —Descriptlon: <br /> FILE ADDRESS <br /> Street N Street Nsma City EHD USE ONLY <br /> 1- 7810 Thorton Stockton <br /> 2. 7676 Pacific Avenue Stockton 0 Unit 1 <br /> 3• 7303 Pacific Avenue Stockton Unit 2 <br /> 4. Unit 2H <br /> S. <br /> 8• ©U//nit 3 <br /> 7• [U'Unit a <br /> 8• 617E MITIGATION <br /> 9. <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ( l UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIL17YNEHICLE <br /> WOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) ❑FOOD FACILITY El DAIRY <br /> ABOVEGROuNo TANK ❑CHICKEN RANCH]DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHASARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPUcATIDN SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLANDSEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 Idendfying 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 flies exist. An appointment for review will be confirmed approximately tan(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 some condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file revlews by the same applicant may require a$130 deposit prior to review. "`BOXED ARF1t-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR-Complete. Staff Name: <br /> Received Time Oct, 2. 2015/ 5, CI-PM--N o. 9693 r"I'a <br />