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�M ca : Advanced GeoEnviroiFax: (707) 570-1461 To: <br />alp DATE RECEIVED <br />SAN JJA <br />Fax: +1 (209) 464-0138 Page 1 of 1 03/11/2016 9:32 AM <br />EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ MOTEUHOTEL <br />UIN COUNTY <br />❑ HOUSING ABATEMENT <br />❑X UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ WASTE TIRE <br />® ABOVEGROUND TANK v< <br />❑ CHICKEN RANCH/ DOG KENNEL <br />X HAZARDOUS WASTE C� <br />FILE ADDRESS <br />® HAZARDOUS MATERIALS <br />1868 East Hazelton <br />e e, Stockton, CA 95205-6232 <br />❑ COMPLAINT/RESPONSE RECORDS <br />L'04.elephone: (209) 468-3420 Ea <br />: ( 9) 464-0138 Web: vwvw.sjgov.org/ehd <br />EHD USE ONLY <br />Street # <br />Street Name City <br />1 ° <br />747 <br />t�I'y1:/irfell��.lEfti E,'''': I'L1'P_Imtl <br />Ply LIC aECORDS RELEASE APPLICATION <br />-9/ .Ajo <br />{70 f?w <br />n 11_nit 1 <br />u <br />2. <br />3775 <br />N. Tracy Boulevard Tracy <br />3• <br />APPLICANT: Jennifer Berjikian <br />ADDRESS: 3335 East Miraloma Avenue <br />BUSINESS/AGENCY: Advanced GeoEnvirommnetal, Inc. <br />CITY/STATE/ZIP: Anaheim, CA 92806 <br />PHONE (1): 800-511-9300 PHONE (2):209-483-3401 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 � 'y ELATE 03/11/2016 <br />Electronic Information: ❑ List ❑ry[M�ap — Description: <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ MOTEUHOTEL <br />® OTHER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑X UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ WASTE TIRE <br />® ABOVEGROUND TANK v< <br />❑ CHICKEN RANCH/ DOG KENNEL <br />X HAZARDOUS WASTE C� <br />FILE ADDRESS <br />® HAZARDOUS MATERIALS <br />❑ TATTOOIBODY PIERCING <br />❑ TIERED PERMITTED FACILITY <br />❑ COMPLAINT/RESPONSE RECORDS <br />EHD USE ONLY <br />Street # <br />Street Name City <br />1 ° <br />747 <br />Larch Road <br />Tracy�c) <br />-9/ .Ajo <br />{70 f?w <br />n 11_nit 1 <br />u <br />2. <br />3775 <br />N. Tracy Boulevard Tracy <br />3• <br />3725 <br />N. Tracy Boulevard <br />Tracy <br />AJD 0Q ,5, <br />❑ Unit 2 <br />4° <br />3778 <br />N. Tracy Boulevard - <br />Tracy <br />O <br />❑ Unit 2H <br />y <br />5. <br />3,940 <br />N. Tracy Boulevard <br />Tacy <br />Td ®1 6-- <br />z Unit 3 <br />C° <br />999 <br />Tracy Boulevard � <br />Tracy <br />4_ j 0 <br />Unit 3HM <br />tatu' <br />16850 <br />Tracy Boulevard <br />Tracy <br />1 /V,) <br />Unit4 <br />R• <br />j SITE IVIi T iGA' l lUN <br />❑ Unit 5 <br />10. <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ MOTEUHOTEL <br />® OTHER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑X UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ WASTE TIRE <br />® ABOVEGROUND TANK v< <br />❑ CHICKEN RANCH/ DOG KENNEL <br />X HAZARDOUS WASTE C� <br />❑ MEDICAL WASTE FACILITY <br />® HAZARDOUS MATERIALS <br />❑ TATTOOIBODY PIERCING <br />❑ TIERED PERMITTED FACILITY <br />❑ COMPLAINT/RESPONSE RECORDS <br />to <br />t <br />❑ SOLID WASTE FACILITYNEHICLE <br />❑ FOOD FACILITY <br />❑ DAIRY, POOUSPA U.,(,!/� (,Lne f <br />❑ WASTEWATER TREATMENT PLANT 7 - <br />PUMPER <br />PUMPER T RUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ 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. 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 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 clays 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 atthe expense of the applicant. <br />Future file reviews by the same applicant may require a $130 deposit prior to review. <br />* BOXED AREA - EHD USE ONLY— <br />�1 <br />F Records nrovided by Staff -`SPR Comnlete. Staff Name: <br />Received Time=Mar, 11.-2016® 9:310#No.0577 <br />