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Advanced GeoEnvirmFax:(707)570-1461 To: Fax: +1 (209)464-0138 Page i of 1 0411912016 3:32 PM <br /> Igo 1 ID r EHD LOG NUMBER <br /> DA ` En `rt SAN JOAQUIN COUNTY <br /> 'gg EN*ONMENTAL HEALTH DEPARTMM��' <br /> - till <br /> VAPR 2 0 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> EWRONMENTALHEA! H. <br /> RM <br /> PEITiSEWCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berjikian BUSINESSIAGENCY: Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITYiSTATEOP:Stockton, CA 95215 <br /> PHONE(1): 209-467-1006 PHONE(2):209-483-3401 FAX OR E-MAIL:jberjiklan@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 date and time to review the requested records. <br /> I CHECK BOX TO EXPEDITE REQUEST::.S13A FEE:LCA$H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (?. � / — DATE _ <br /> Electronic Information: ❑ List ❑ Ma: <br /> FiLE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City <br /> , , <br /> 1. 3755 West Lane Stockton ! _r <br /> 2 ❑ Unit 1 <br /> 3. <br /> Unit 2 <br /> 4. <br /> ❑Unit 2H11 .t�17,j <br /> 5. �Q <br /> Unit 3 <br /> 6. <br /> � Unit 3HM <br /> /. <br /> ❑ Unit 4 <br /> SITE MITIGATION <br /> 9. <br /> 10. ❑ unit 5 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY IQ!�,� � ry� <br /> Q UNDERGROUND TANK(MONITORINGiREMOVAL(�Z ❑WASTE TIRE ❑DAIRY,POOLISPA i.[171 <br /> x❑ABOVEGROUND TANKC/, ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X❑HAZARDOUS WASTEpC ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> X❑HAZARDOUS MATERIALS ❑TATTOOiBODY 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:OOPM(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 atthe number noted above. <br /> 3. The EHD will notifythe applicant if any EHD files exist. An appointmentfor 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. <br /> "*BOXED AREA-EHD USE ONLY" <br /> F1 Records nrovided by Staff-PPR Cmnlete. staff Name: <br /> Received Time=Apr, 19. =2016= 3:32PAo. 0712 <br />