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09/11/2014 11:05 'tAX) P.0011001 <br /> ■ <br /> I ■ <br /> ■ <br /> ■: DATE RECEIVED EHD LOG NUMBER <br /> 'i SAN JOAQUIN COUNTY <br /> ■ RE.(3EIV ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 j*q <br /> SEP Z-014 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,$)gov.org/ehd <br /> ENVIRONMENTAL <br /> PERM 117SE VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jennifer Berlikian BUSINESS/AGENCY: Advanced Geo Environmental <br /> AQDRESS: 837 Shaw Road CITY/STATEIZIP: Stockton/ CA /95215 <br /> PHONE (1): 209-467-1006 PHONE (2): 209-483-3401 FACSIMILE: 209-467-1118 <br /> TENTATIVE*APPOINTMENT DATE: ASAP Time: <br /> (Please allow 10 business days from date of appIlGation submittal-'Tentet/ve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE ST ZI25.FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE Mu l iq <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unft 1 <br /> 1. 633 East Market Street s (�(� Stockton ,i Il z <br /> y, 625 East Market Street .tfJ Stockton �./� Unit �) <br /> 3. <br /> 4. <br /> Unit 3 <br /> Untt 4 <br /> 7. <br /> 6. <br /> Untt 6 <br /> LO <br /> 0�Unit 6 <br /> Specific Dato Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Qx UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑x SOLID WASTE FACILITINEHICLE <br /> ❑x OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑x WASTE TIRE <br /> ❑X UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL M DAIRY <br /> ❑x HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATERTREATLEff PLANT <br /> ❑x <br /> TIERED PERWMDFACIIITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARWCHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑PODUSPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q COMPLAINT RECORDS ❑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 flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-01;8 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 appilcant If any EHD flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 ba 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 vrlll be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 48.03 pryl�l <br /> Received Time Sep- 11, 2014 10. 53AM No, 1029 <br />