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■ :Advanced GeoEnviroiFox:(707)570-1461 To: Fax: +1 (209)464-0138 Page 1 of 1 03/11/2016 9:32 AM <br /> :DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ■ <br /> ■f■ <br /> 1868 East NMEon Avenue, Stockton, CA 95205-6232 <br /> FEAR 11 20filephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwv✓.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> tRIVII / tri. I c <br /> APPLICANT: Jennifer Berjikian BUSINESS/AGENCY: Advanced GeoEnvirommnetal, Inc. <br /> ADDRESS: 3335 East Miraloma Avenue CITY/STATE/ZIP:Anaheim, CA 92806 <br /> PHONE (1): 800-511-9300 PHONE(2):209483-3401 FAX OR E-MAIL: jberjikian@advgeoenv.com <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 03/11/2016 <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 1 747 Larch Road Tracy <br /> 2, ❑ Unit 1 f <br /> 3775 N. Tracy Boulevard Tracy I <br /> 3. 3725 N. Tracy Boulevard Tracy ❑ Unit 2 <br /> 4, 3778 N.Tracy Boulevard Tracy ❑ Unit 2H <br /> 5. 3940 N. Tracy Boulevard Tacy Unit 3 <br /> 6' 999 Tracy Boulevard Tracy <br /> Unit 3HM <br /> 16850 Tracy Boulevard Tracy ❑ Unit <br /> 8. SITE MITIGATION <br /> 9. <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> © UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITY/VEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑ HOUSING ABATEMENT ❑ FOOD FACILITY <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) <br /> E]WASTE TIRE El DAIRY,P0011SPA <br /> X1 ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X❑HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑ LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW: MDNDAY-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(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 identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notifythe 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 /> 4. Anyfile 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$130 deposit prior to review. <br /> Ask "**BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Comnlete. staff Name: <br /> Received Time=Mar. 11. -2016= 9: 31AMFNo, 0577 <br />