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1111012015 15:27 (FAX) P.0011001 <br />� <br />F-U, <br />ec TV F, U SAN JOAQUIN COUNTY EM LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />�. igov a 0 2015 1868 East Hazelton Avenue, Stockton, CA 05205-6232 r ko <br />13 -OU 1 IV1n�Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br />ENVIRONMEN1, L <br />111=81 r' I— PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:_ Jennifer 9erjiklan BUSINESS/AGENCY: advanced GeoEnvironmental <br />ADDRESS: 837 Shave Rood <br />CITY/STATEIZIP: Stockton, CA 95215 <br />PHONE (1): 209-467-1006 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 />❑ GHECK BOX TO EXPEDITEUE -1130 F (CASH OR CHECK ONLY) - REGILIEST PROCESSED IN 3 USINESS DAYS <br />SIGNATURE OF APPLICAN r– DATE �I�1 4 <br />Electronic Information: ❑ List Map –Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />I <br />Street # <br />Street Name <br />City <br />1. <br />213 <br />South Kelly <br />Loci <br />U y j v JULax <br />=` <br />0Unit 1 <br />2. <br />214 <br />South Kelly <br />Lodi <br />iin <br />3, <br />224 <br />South Kelly <br />Lodi <br />FI Unit 2 <br />4. <br />77 <br />South Cluff Of v <br />Lodi <br />Unit 2H <br />g <br />E351 <br />East Lodi Avenue <br />Lodi <br />UZ ; <br />L-t� E�I�t 3 <br />6. <br />7. <br />IJ'untt 4 <br />QITE WrIG ". O <br />9. <br />9. <br />Dunk 5 <br />10. <br />_ <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL Hi=ALTH DEPARTMENT FILES <br />q UNDERGROUND TANK (GIST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLIO WASTE ACILITY EHICLE <br />Q OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT O WASTE TIRE CN ICI je _5 <br />Q UNDEROROUND TANK (MONITORING/REMOVAL- © F000 FACILITY ❑ QAIRY -j C' 0Z3 Z3 LS <br />Ej ABOVEGROUND TANK ' ❑ CHICKEN RANCH/ DOG LA <br />KENNEL �3WASTEWATER TREATMENT NT <br />[J AAZARDOUS WASTE]HAZARDOUS MATERIALS V ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />Q TIERED PERMITTED FACILITY ❑ POOLISPA ❑!(AND USF APPLICATION SITES <br />❑ TATTOO/BODY PIERCING COMPLAIN"T)RESPONSE 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 un 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 Indlcated above. Address <br />ranges wlll 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 H any EHD flies 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 $130 deposit prior to review. ***BOXED AREA - EHD USE 0NLY— <br />FHD 46,06 <br />1AFAM <br />Yom_ <br />z3-15 <br />I <br />(5 'G��YI fk <br />I t: <br />❑ Records provided by Staff-PIOR <br />Complete. staff Name: <br />FHD 46,06 <br />1AFAM <br />Yom_ <br />