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r S • �QQ ,WPECE1VEQnvironmer,.,1 Health Department <br /> ---C OU N T Y-- - ADR 0 9 201S P L]Ct6pFf RELEASE APPLICATION <br /> GrLctr;�ss nrctrc hc��. <br /> ENVIRON,MEN M EHD LOG NUMBER: <br /> APPLICANT: Rebecca Natal BUSINESS/AGENCY:Advanced GeoEnvironmental,Inc. <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton/CA/95242 <br /> PHONE (1): 209-467-1006 PHONE(2):209-623-7200 FAX OR E-MAIL: rnatal@advgeoenv.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ot'e°;o,a:o°o9',o>3Q D7 N DATE 4-9-2018 <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(cDsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map–Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only, address ranges will not be acce ted <br /> ®Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) I-1M ❑CONSUMER <br /> 1 <br /> QX Other Cleanup Site(Non-LOP) 3001 Navone Rd Stockton <br /> Q Hazardous Waste DAIRY <br /> Q Tiered Permitted Facility 2908 Bozzano Rd Stockton "`'� ❑ <br /> FX Aboveground Tank <br /> ❑X UST (Monitoring/Removal) ❑PWS <br /> FRI Hazardous Materials 3 2881 Navone Rd Stockton Nv <br /> Q Spill/Release Response <br /> WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 3301 Navone Rd Stockton ►,,� <br /> �`_ <br /> F—] Food Facility <br /> ❑Pool/SpaSITE MITIGATION <br /> Dairy 5 s i <br /> ❑X Land Use Application Sites <br /> Septic Pumper Truck/ s ❑HOUSING <br /> Yard/Chemical Toilets rLG <br /> FX Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 ' } AST/HM/HW <br /> Motel/Hotel V <br /> F]Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility <br /> $ UST <br /> Tattoo/Body Piercing <br /> SOLID WASTE <br /> Q Waste Tire 9 <br /> Q Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY**' <br /> L �c�.t ., �L► Iter a a� MOL `+, ' :rr.e d .SkAo ( 1 Tilcx. 0_0,A 0151— <br /> El <br /> 151 -❑ Records provided by Staff-PPR Complete. Staff Name: EHD48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />