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■ :Advanced GecEnviroiFex:(707)570-1461 To: Fax: +1 (209)464-0136 Page 1 of 1 0411912016 3:32 PM <br /> DAIM EHD LOG NUMBER_, [� J �iC CJEN COUNTY <br /> s■� EN ONMENTAL HEALTH DEPARTMMT <br /> APR 2 O 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwwv.sjgov.org/ehd <br /> PERMFr/SEWCES ' PUBLIC RECORDS DECEASE APPLICATION <br /> APPLICANT: Jennifer Ber)ikian BUSINESSIAGENCY: Advanced Geo Environmental <br /> ADDRESS: 837 Shaw Road C(TYISTATEIZI P:Stockton, CA 95215 <br /> PHONE(1): 209-467-1006 PHONE (2):209-483-3401 FAX OR E-MAIL:jberjikian@advgeoenv.com <br /> Please allow 10 business days from nate 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 R EQ U EST,7.Sj3Q F.EE.(-CASH.QR CHECK ONLY)- REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> Electronic Information: ❑ List ❑ Ma .. <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street 4 Street Name City <br /> "0 r <br /> 3755 West Lane Stockton -­?T t 1 <br /> 2 ❑ Unit 1 <br /> 3. <br /> Unit 2 <br /> 4. <br /> ❑Unit 2H J 1,,, <br /> 4? <br /> [TUnit 3 <br /> 6. <br /> Er/Unit 3HM <br /> 1. <br /> i❑ Unit d <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 /> K]OTHERCLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY ,1 <br /> X❑UNDERGROUND TANK(MONITORINGIREMOVAL)X ❑WASTE TIRE <br /> K ABOVEGROUND TANK ❑DAIRY POOLISPA <br /> ❑ � d CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANTr��_Gl 4 <br /> HAZARDOUS WASTEC>G ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> Q HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> [�TIERED PERMfTTED'FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEVII: 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)464-0136 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 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 prior to review. <br /> ***BOXED AREA-EHD USE ONLY*** <br /> f-! Records nrovided by Staff-PPR Comniete- Staff Name: <br /> Received Time=Apr. 19. =2016= 3:32PN--No. 0712 <br />