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In K <br /> C :Advanced GeoEnviroiFax:(707)570-1461 To: 209464013£@rcfax.con Fax: +12094640133 Pace 1 of 1 03/0712016 9:16 AM <br /> �RQDATE REC V � ® EHD LOG NUMBER <br /> �mEREC I V E SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> IL MAR 0201� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: \vwvd.sjgov.org/ehd <br /> " NMIRONMENTAL BE4L�l'2 <br /> PERMITISEWCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berjikian BUSINESS/AGENCY:Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIp:Stockton, CA 95215 <br /> PHONE (1): 800-511-9300 PHONE(2): 209-483-3401 FAX OR E-MAIL: 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 /> ❑ CHECK BOX TO EXPEDITE REQUFCT_'z1 zn PGG irocu nR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r y DATE 3-7-16 <br /> r <br /> Electronic Information: ❑ List❑ rvraN—vc�w rNuvr r. <br /> FILE ADDRESS <br /> _ EHD USE ONLY <br /> Street# Street Name City <br /> 1. 1601 East Madruga Road Manteca <br /> i r <br /> 2. ElUnit 1 <br /> 3. Slzunit 2 <br /> 4. ❑ Unit 2H <br /> 5. <br /> ® Unit 3 <br /> O'Unit 3HM <br /> I] Unit 4 <br /> 8: <br /> 'SITE MITIGATION <br /> 9. <br /> 10. <br /> ❑ 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 FACILITYJVEHIC � ' ` ��//�� <br /> X❑OTHER CLEANUP SITE(NON-LOP) ❑ HOUSING ABATEMENT ,' CA4— 6 <br /> ❑ FOOD FACILITY � �i� ���2 <br /> ❑X UNDERGROUND TANK(MONITORINGIREMOVAL)'L ❑WASTE TIRE ❑ DAIRY,POOUSPA'�/J"( f. N� <br /> X❑ABOVEGROUND TANK ,,L ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 0 HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ®HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑ LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINT/RESPONSE RECORDS ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00Prii(DiCLUDING 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 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 /> shoui'd be scheduied accurdingiy. <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 bythe same applicant may require a $$130 deposit prior to review. <br /> `"*BOXED AREA-EHD USE ONLY— <br /> - <br /> ❑ Records nrovided by Staff-PPR Complete. Staff Name: <br /> Received Time=Mar. 7, =2016= 9: 160#No. 0540 <br />