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13'� 1110512015 15:57 (FAX) P.001/002 <br /> � DATE REC [VED ' �' EHD LOG NUMBER <br /> �- Aid �C1A4E�EN f}WTY n� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 0 6 2055 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> rN\ri R0IdMENTAL IiEALTH <br /> PERIJITISERVICES PUBLIC RECORDS RELEASE APPLICA s [Ot\11 <br /> APPLICANT: Jennifer Berjikian BUSiNESSIAGENCY:Advanced GeOEnviron rental <br /> ADDRESS: 3335 E. iViiraloma Ave Suite 142 CITY/STATE/ZIP: Anaheim, CA 92806 <br /> PHONE (1): 714-529-0200 PHONE (2): FACSIMILE: 209-467-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff vrill contact you to arrange an appointment date and time to review the requested records. <br /> HECK BOX TO EXPEDITE::OjUj -=$13F H OP CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS _SIG ATUTRE OF APPLICANT DATE �C (�S l T <br /> Electronic In ❑ List Map—Description: <br /> FILE ADDRESS <br /> Street Street Name City EHD USE ONLY <br /> 1. A020 Newton Road Stockton <br /> 2. <br /> Unit 1 <br /> 3. <br /> Unit 2 <br /> 4. <br /> Unit 2H <br /> 5. <br /> Unit 3 <br /> 7. ©Unit 4 <br /> &. <br /> ITE M[71C3ATI0N <br /> ❑,U t S <br /> n <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSINO ABATEMENT PTWASTE TIRE <br /> [UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> [ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 0-HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LANG USE APPLICATION SrrEs <br /> ❑TATTOOIBODY PIERCING KI COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00P1a(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(as). At least one file type MUST be selected. Fax to(200)464.01 mor mall to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will ba processed the next business day. <br /> 2. For assistance in Identifying the nature and content of EHD records,please contact EMD at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD flies exlst. An appointment far 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$130 deposit prior to review. *"BOXED AREA-EHD USE ONLY'— <br /> ❑ Records provided by Staff-PPR Complete. staff Hama: <br /> ENo 4e4e <br /> Received Time Nov, 5, 2015 3 :49PM d'o, 9958 <br />