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m 1RECEIVED <br /> 210512016 09:25 (FAX) P.0011001 <br /> ff <br /> 05 1 <br /> •r RYA EVE® EHD LOG NUMBER <br /> SAN.10A0UIN COUNTY <br /> • DEC 0 5 2016 ENVIRONMENTAL HEALTH DEPARTMENT n n <br /> 1868 East Hazelton Avenue, Stockton, CA 85205-8232 <br /> ENVIRONMENTAL HEALTH Telephone: (209)488-3420 Fax: (209)484-0138 Web:www,sjgov.org/ehd <br /> __PERMITISERVICFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; Erin Rottacker BUSINES81AGENCY:Advanced GeoEnvironmental„Inc. <br /> ADDRESS: 837 Shaw Road CITYISTATEZIP:Stockton, CA. 95215 <br /> PHONE(1): 209-467-1006 PHONE(2): FAX OR E-MAIL:erottack-rpadvgeo8nv com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will conApt you to arrange an appointment date and time to review the requested records. <br /> F-1CHECKBOX TO EXST 139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 DUSI ESS DAV <br /> E 1 E REQE <br /> SIGNATURE OF APPLICANT DATE •j- bf I o <br /> 1, LIM up to ton addrosalf1h.4ho space below. Select the type(s)of files from the)let below by chockInIg 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.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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electron le 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 /> • ®UNDERGROUND TANK(UST) Street# Street Name City <br /> p� <br /> CLEANUP Sire(LOP) ,� L0 ❑CoNaunK <br /> ®OTHER CLEANUP SITE(NON-LOP) ' 1116 East First Street Stockton p/ <br /> ®HAZARDOUS WASTE ❑DugV <br /> ®TIERED PERMITTED FACILITY <br /> ®ASOYEGROUND TANK 1_rU�NSE� `a J• <br /> (MUST (MONITORING/REMOVAL) !V Cl Pwb <br /> ®HA}ARDOVS MATERIALS <br /> ®SPILIIRELEABE RESPONSE <br /> ❑SOLID WASTE FACILITY/VEHICLE < WAiER GwurY <br /> ❑FOOD FACILITY <br /> p POOL/SPA aliE LITIGATION <br /> DAIRY 3 <br /> ®LAND USE APPLICATION SITES <br /> Il SEPTIC PUMPER TRUCK I ❑HOb01NG <br /> e <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PUNT <br /> [yj CUPA <br /> �HOUBINDAEATEMENT T <br /> MOTEL/HOTEL <br /> ❑ <br /> CHICKEN RANCH/OOG KENNEL TI CUPA-UST <br /> MEDICAL WASTE FACILITV S <br /> ❑TATTOD10ODY PIERCING <br /> ❑WASTE TIRE U SOLI4 WAnr <br /> rl B <br /> CONRAINT <br /> OTHlR(PLEASE SPECIFY): <br /> ACOIUMTIXD <br /> 10 <br /> • -'BOXED AREA-ANG USE ONLV•^ El <br /> d Records provided by Staff-PPR Complete. saff Name; <br /> Received Tlme Dec. 5. 2016 9: 04AM 11o. 0434 <br />