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GEIVED <br /> SAN <br /> Q Q ( N 2 5 2018 Environmental Health Department JOU <br /> ---C OU N T '-- - AXUBLIC RECORDS RELEASE APPLICATION <br /> ii0.t+1lAEWAL F! V10 <br /> ���� N1�IT BY EMAIL q0 <br /> • EHD LOG NUMBER. ���/// 52. <br /> APPLICANT: Rebecca Natal BUSINESS/AGENCY:Advanced GeoEnvironmental,Inc <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton,CA 95215 <br /> PHONE(1): 209-467-1006 PHONE(2):209-623-7200 FAX OR E-MAIL: Rnatal@advgeoenv.com <br /> Please allow 10 business days from date of application submittal or the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE 25zols <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> address indicated below, or email to info(a)sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 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❑ Map–Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS -'�V 7 <br /> HEALTH DEPARTMENT p y 9 p ) EHD USE ONL <br /> FILES (Specific addresses only, address ran es will not be acce ted <br /> ❑X Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUMER <br /> 1 1850 E Louise A rop <br /> • X Other Cleanup Site(Non-LOP) Ir, D <br /> FX Hazardous Waste Y`r N111115 <br /> MVV <br /> DAIRY <br /> RX Tiered Permitted Facility 2012112 E Louise Ave Lathrop N t- <br /> Q Aboveground Tank " LUQ"c <br /> FX]UST (Monitoring/Removal)Hazardous Materials ❑PWS <br /> FXI 3 1700 E Louise Ave Lathrop <br /> v" mea <br /> ^t <br /> []Spill/Release Response 100 <br /> culla <br /> io <br /> � ' <br /> '��t"4'N 1�'-T ATER QUALITY {(/� <br /> ❑Solid Waste Facility/Vehicle 4 2050 E Louise Ave Lathrop �� <br /> ❑ Food Facility `` <br /> [—] Pool/Spa Q16TE MITIGATION <br /> ❑ Dairy 5 <br /> Q Land Use Application Sites <br /> ❑Septic Pumper Truck/ 6 ElHOUSING <br /> Yard/Chemical Toilets <br /> [xj Wastewater Treatment Plant Q•&PA <br /> Housing Abatement 7 AST/HM/HW <br /> F]Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility $ UST <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire g <br /> X Complaint <br /> E]Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> 4� ***BOXED AREA-EHD USE ONLY*** <br /> 7-7 <br /> 74-)1114 IF a <br /> • W— . <br /> ❑ Records provided by Staff-PPR Complete. staff Name EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />