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:AdvEyjv' pu/F 707 57G-1461 To: <br />Fax: +1 (209) 4640138 Page 1 of 1 06/28/2016 9:34 AM <br />g DAT -I -1 EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN Q.o <br />s JUN 2 "5 2016 1868 East Hazelton Avenue, Stockton, CA 95205-q" <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www. )g .o d <br />FIEAt <br />EI�V[RQ(e'f��EttiTAt_TH PUBLIC RECORDS RELEASE APPLICATION <br />oF�sr�IrA� <br />--APPLICANT: Jackie Hyman BUSINESS/AGENCY: Advanced GeoEnvironmental <br />ADDRESS: 3335 E. Miraloma Ave. Suite 142 CITYiSTATE/ZIP: Anaheim, CA 92806 <br />PHONE (1): 800-511-9300 PHONE (2): FAX OR E-MAIL: jhyman _adygeoeny.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 />Q CHECK BOX TO EXPEDITF RFOt1FST - %130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT_, , DATE 27 June 2016 <br />1. List up to ten addresses in the space Detow. Select the type(s) of files from the list below 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 days for review. Appointments <br />should be scheduled accordingly. <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 $13d deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic information: ❑ List ❑ I'Vilap - Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FIDE ADDRESS <br />� US� (ONLY LY <br />FILES <br />- <br />®UNDERGROUNOTANK (UST) <br />Street <br />Street Name <br />City <br />22 <br />Houston Lane <br />Lodi <br />I3 CONSUMER <br />�Iyv <br />CLEANUP SITE (LOP) <br />=-] OTHER CLEANUP SITE (NON -LOP) <br />1 <br />® HAZARDOUS WASTE <br />O DAIRY <br />❑ 71ERED PERMITTED FACILITY <br />Q <br />28 <br />Houston Lane <br />Lodi <br />� <br />® ABOVEGROUND TANK <br />21 <br />Houston Lane <br />Lodi <br />PWS <br />f,UST (MON—ITOP.ING/REMOVAL) <br />® HAZARDOUS MATERIALS <br />® SPILL/RELEASE RESPONSE <br />17 <br />Houston Lane <br />_ _ _ <br />Lodi <br />Cg/WATER QUALITY' <br />❑ SOUD WASTE FACILITY/ VEHICLE01 <br />❑ FOOD FACILITY <br />4 <br />Houston Lane <br />LodlI�ry <br />SITE M RI GATION <br />•C <br />l'rv�7J� <br />POOL/ SPA <br />❑ DAIRY <br />LAND USE APPLICATION SITES <br />0 }{OUclnln <br />SEPTIC PUMPER TRUCK / <br />B <br />YARD / CHEMICAL TOILETS <br />❑ WASTEWATER TREATMENT PLANT <br />QICUPA <br />HOUSING ABATEMENT <br />T <br />MOTEUHOTEL <br />B/CUPA - HAZ-MAT <br />CHICKEN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />8 <br />TATTOO/BODY PIERCING <br />SOLID WASTE <br />WASTE TIRE <br />9 <br />COMPLAINT - <br />❑ ACCOUNTING <br />OTHER(PLEASE SPECIFY): <br />10 <br />ig <br />