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a <br /> f�Advanced GeoEnviraFax:`(7007)570-1461 To:2094640132@a7icfax.ccn Fax: +12094644136 Page 1 of 1 0313112018 4:CS PM <br /> y�l]A 1 iq(s E SIGN JOAQUIN COUNTY <br /> EHD LOG NUMBER <br /> N� EI'N V l©lrl MENTAL HEALTH DIvl'�A1�DEPARTMENT <br /> s� APR 0 1 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvwW,sjgov.org/ehd <br /> RONMEWAL HEALTH <br /> €aERMFUSEWCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berjikian BUSIN ESSfAGENCY:Advanced GeoEnvironmentai <br /> ADDRESS: 3335 East Miraloma Avenue CITYISTATEIZIP:Anaheim, CA 62806 <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 Gate and time t0 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 s PATE 0313112016 <br /> a <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILEADDRESS <br /> EHD USE ONLY <br /> Street 4 Street Name City <br /> 1' 686 East LocIdord Lodi <br /> 2• 900 1/2 East Victor Road Lodi Unit 1 <br /> 3. 930 East Victor Road Lodi Q/Unfi 2 <br /> 4. 1220 East Victor Road Lodi _ t <br /> t 'P Unit 2H <br /> 5. 687 East Lockford Street Lodi { . <br /> �• !VJV��t <br /> 'r7� 111"Unit 3 <br /> �'' 681 East Gackford Street Lodi <br /> I. _ . �C1 E nit 3HM <br /> l' 925 South Victor Street Lodi V �5 / ❑ Unit 4 <br /> s. &50 �or�K Low I11� N� / lg SITE Mi DATION <br /> ti. f Aho 0. ❑ Unit 5 <br /> + Ap. r No r,-lb— J4r� �/din <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> 0 El TANK(UST)CLEANUP SITE(LOP) ❑MOTEL/HOTEL SOLID WASTE J <br /> FACILITY/VEHICLE X <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑Food FACILITY 0 5 kf 6" <br /> X❑UNDERGROUND TANK(MDNITORINGIREMOVAL)x ❑WASTE TIRE <br /> ❑DAIRY,FOCUS PA l.tJ'I%'I .(421 <br /> 7C❑ABOVEGROUND TANK o9( ❑CHICKEN RANCH[DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE�� ❑MEDICAL HASTE FACILITY ❑PUMPER T RUCKIYARDICHEMICAL TOILETS <br /> 0 HAZARDOUS MATERIALS ❑TATTOOMODY PIERCING ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE 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 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 EHID 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 $130 deposit priorto review. <br /> ***BOXED AREA-EHD USE ONLY*** <br /> H-llfl - UOU &W J' r U -J-A5-0 -Iv _ <br /> S <br /> �df� <br /> ,rovlded Ix eceivme=Ma r. 31, 2016=`4 No. 064� <br />