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12/22/2015 11:59 (FAX) P-0011001 <br /> ■ <br /> ■ E `) SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1153 <br /> DEC 22 2915 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax., (209) 464-0138 Web: www.sjgov.org/and <br /> RVARGNINMEINITAL'HEAU J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berjikian BUSINESS/AGENCYAdvanced GeoEnvironmentel <br /> ADDRESS: 837 Shaw Road CITY/STATMP: Stockton,CA 95215 <br /> PHONE (1); 209-467-1006 PHONE(2):209 83-3401 FAX OR E-MAIL:209-467-1 Ile <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 REE EE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 12/22/2015 <br /> Electronic Information: ❑ Lle sp –Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> F27 <br /> Stmot Name city <br /> eWest Yosemite Avenue Manteca <br /> ❑Unit 1 <br /> West Yosemite Avenue Manteca <br /> IV <br /> • V <br /> 'nit Z <br /> 4. <br /> ❑Unit 2H 1Z� - <br /> 5. <br /> 6. <br /> UUnit 3HM <br /> 7. <br /> a unit 4 <br /> 8' EISITE MITIGATION <br /> 9. <br /> 10. dLrnit s <br /> Specific Date Range of Inrennalim Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEUHOTEL ®SOLID WASTE FACILI ICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> ®UNDERGROUND TANK(MONITORINGIREMOVALV ❑WASTE TIRE ❑DAIRY,POOUSPA 1t12) <br /> ®ABOVEGROUNDTANK-� ❑CHICKEN RANCWDOG KENNEL ®WASTEWATER TREATMENT PLANT <br /> ©HAZARDOUS WASTEc" ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> Q HAZARDOUS MATERIALS ❑TATTOOISODY 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 11:00 AW5:OOPM(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(ea). At least one file"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 busineas 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 If any EHD files exist. An appointment for review will be confirmed approximately ten It 0) <br /> days after receipt or application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4- Any fila 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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Dec. 22. 2015 11 : 50AM No. 0242 <br />