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DATE RECEIVED NftwvUNTY EHD LOG NUMBER <br /> ECEIVED <br /> ENVIRON T r2DEPARTMENT • <br /> 3 0 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIROW-1ENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ally Colavita BUSINESS/AGENCY: Advanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton/CA/95215 <br /> PHONE (1): 209-467-1006 PHONE(2): 209-483-3401 FACSIMILE: 209-467-1118 <br /> TENTAT/VE'APPOINTMENT DATE: ASAP Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> dCHECK BOX TO EXPEDITE REQUEST-$122 FEE(C S OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 5- 30 -0 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> El Unit 1 <br /> — <br /> 2. <br /> — -- _nit 2 <br /> 3. 3(, 35 <br /> 4. 3 SS <br /> nit 3 <br /> 6. G45 <br /> Unit 4 <br /> 7• .Z00 IVIW-1.,t' - <br /> $• 3 30o <br /> 9. ❑unit 5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range Df Information Requested: From All to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA <br /> ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 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)464-0138 or mail 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 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 <br /> 07/29/10 <br />