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loo 10/2412014 08:22 (FAX) P.0011001 <br /> I ❑ <br /> 0 <br /> ID <br /> 0 <br /> �0 DATE RECEIVED EHD LOG NUMBER <br /> y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> o�T 2 c lrelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/and <br /> l rVo' <br /> Et4VIA()NMFt4TAL EA1 <br /> PERM f PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Jennifer Beriiklan EUSINESS(AGENCY:Advanced GeoEnviron mental <br /> ADDRESS: 837 North Shaw Road CITY/STATE/ZIP: Stockton, CA . <br /> PHONE(1): (209)467-1006 PHONE(2):(209)483-3401 FACSIMILE: (209)467-9118 <br /> TENTATIVE*APPOINTMENT DATE: ASAP Time: <br /> (Please allow 10 business days from date of application submittal-"Tonfetivo only-must be can rme ) <br /> [:] CHECK BOX TO EXPEDrTE OU $125 FEE OR CHECK ONLY)-REQUEST PROCESSED IN I I!nYt4SIGNATURE OF APPLIC DATE <br /> Electronic Information: Map—Description: -71 <br /> FILE ADDRESS EHD USE 5NLY <br /> Street# Street Name City Unit 1 <br /> 1. 3400 Newton Road Stockton 10) <br /> 2. 3516 Newton Road Stockton -116 r Unite <br /> 3. 3535 Cherokee Road Stockton <br /> 4- 3655 East Cherokee Road Stockton to r •1 I unit 3 <br /> 6. <br /> (]"Unit4 <br /> 7. <br /> 8. <br /> unit e <br /> 9. <br /> Specific Date Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑x <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT N-1SOLIDWASTE FACILfiYNEHICLE <br /> ❑x OTHER CLEANUP SITE(NON-LOP) ❑FODD FACILITY ❑x WASTE TIRE <br /> D UNDERGROUND TANK(MONITORINGfREMOVAL) ❑DOG KENNEL Q DAIRY <br /> Q HAZARDOUS WASTE G ENERATOR ❑CHICKEN RANCH ❑WASTEWATERTREATNIENT PLANT <br /> Q TIERED PERMITTED FACILITY Q MOTEL/HOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TATTO01BODY PIERCING ❑P001JSPA ❑LAND USE APPLICATION STIES <br /> d MEDICAL WASTE FACILITY ❑x COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANI-5:00PM(EXCLUDING HOLIDAYS) <br /> I. 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. rax to(2081484-0138 or mall to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. 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 file 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 /> 4. Any file not retumod in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by tha same applicant may require a$128 deposit prior to review. <br /> EHD USE ONLY <br /> EHD A" <br /> Received Time Oct. 24, 2014 8: 04AM No. 7401 <br />