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0112512012 14:59 Advanced GeoEnviromental Inc. (FAX)209 4671118 P.0011001 <br /> pffepy EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 9, 5 20600 East Main St. Stockton, CA 95202-3029 <br /> \N 2 15 ?0 Iephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ,ENVIRONMENTAL HE,A �t- <br /> �;NPt� I l <br /> PEFiMMSEHWIG_S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ally Colavlta BUSINESS/AGENCY: Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton/CA 195215 <br /> PHONE(1): 209467.1006 PHONE (2):209-483-3401 FACSIMILE:209467-1118 <br /> TENTATIVE`APPOINTMENT DATE: ASAP Tlme: <br /> (Please allow 10 business days from date of application submittal-"rentative only-must be confirmed) <br /> ❑ CHECK 6OX TO EXPEDITE REQUEST- 125 FEE(C OR EC ONLY)-REQUEST PROCE55ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �x' �" --�- DATE 01126/12 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 8treot4 Street Name City Unit 1 <br /> 1. 1212 PERFORMANCE DRIVE Stockton �� . <br /> 2. C2 Unit 2 <br /> 3. <br /> 4. <br /> 3. <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. 71 <br /> Unit B <br /> 10. S� <br /> Unit a <br /> Spaciflc Data Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP 81TE(LOP) ❑HOU81NO ABATEMENT ®SOLID WASTE FACILITYNEHICL66).Q <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑C WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑000 KENNEL ®DAIRY <br /> Z HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ®PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOISODY PIERCING ❑POOUSPA ®LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ®COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDIN(3 HOLIDAYS) <br /> 1. List up to ten ad reasea In the apace above. Select the type(s)of files from the flat above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(209)464.0138 or mall to the address IndIcated above. Address <br /> ranges will not be accepted,for additional assistance with file addresses,contact the EHb. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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 /> 3. A flie that Is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> a. 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$125 deposit prior to review. <br /> RHO USE ONLY <br /> EHD 4E-OE <br /> 8!1!11 <br />