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D E I Tf' E D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> AUG 16 201/ ENVIRONMENTAL HEALTH DEPARTMENT ?02-(o <br /> 1868 East Hazelton Avenue, Stockton, CA 95205.5232 <br /> EyJVI�I <br /> • ALHEALTH Telephone: (209) 468-3420 Fax: (209)464-0136 Web:www.sjgov.org/ehd <br /> PEmwiT/5ERWCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rebecca Natal 13USINESSIAGENCY: Advanced Geo Environmental, Inc. <br /> ADDRESS: 837 Shaw Road CITYISTATEIZIP: Stockton, CA 95215 <br /> PHONE(1): 209-467-1006 PHONE(2):209-623-7200 FAX OR E-MAIL: rnatal@adygeoenv.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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139F E(CASH O HECK NLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 08/16/2017 <br /> 1, List up to ten addresses in the space below. Select the tye(e)16ffles from the list below by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(209) 4.0138 or mall 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. e <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ❑x UNDEReIbUND TANK(UST) Street# Street Name city <br /> CLEANUP SITE(LOP) El CDNBURER <br /> ❑x OTHER CLEANUP SITE(NON•LOP) ' 1011 North Broadway Ave Stockton lN�' <br /> HAZARDOUS WASTE �� O DAIRY <br /> TIERED PERMITTED FACILITY 2 916 North Broadway Ave Stockton <br /> ASOVEOROUND TANK <br /> ©UST (MONITORING/REMDVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS J <br /> ®SPILURLLEASE RESPONSE <br /> ❑SOLID WASTE FACILITY/VEHICLE A �In 4ll'i WATER QUALITY <br /> r7OO <br /> FD FACILITY /L,�f� „/ <br /> ❑POOL/SPA 0—In M"UT-H <br /> ❑DAIRY a <br /> ❑LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK I El HOU8IRG <br /> e <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PUNT COPA <br /> ❑HOUSING ABATEMENT <br /> ❑MOTRUHOTEL <br /> ❑CHICKEN RANCH/DOD KENNEL COPA-UST <br /> ❑MEDICAL WASTE FACILITY S <br /> f7 TATTOO/BODY PIERCING <br /> SOLID WAYTE <br /> ❑WASTE TIRE <br /> e <br /> ❑COMPLAINT <br /> n OTHER(PLEASE SPECIFY): Acmu"NG <br /> 10 <br /> ^BOXED AREA•k8901i ONLY.. <br /> nni: h <br /> r. <br /> Rec, IvedaT� me�i�Au �Y6.�12011z 11 :N9ALd No,12109 <br />