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■ RECEIVED' <br /> va rol ( 1 To: <br /> Fax: (209)464-0138 of 1 11/02/2017 5:15 PM <br /> ■D E ID SAN JOAQUIN COUNTY opal <br /> EHD LOG NUMBER <br /> i■ _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> �■ ��� ll ��' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwwv.sjgov.org/ehd <br /> EWR0Nt0EXTALt-iMTH PUBLIC RECORDS RELEASE APPLICATION (a74W <br /> — RIWAIT/� F-94CES <br /> APPLICANT: Jackie Hyman BUSINESS/AGENCY: Advanced GeoEnvironmental, Inc. <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton, California 95215 <br /> PHONE(1): 800-511-9300 PHONE(2): FAX OR E-MAIL: jhyman@advgeoenv.com <br /> Please allow 10 business days from date of application submittal fort he records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEnITG Prnl JEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_I0"r— DATE 11/02/2017 <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below 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.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 maximufive usiness days for review. Appointments <br /> should be scheduled accordingly. J: <br /> 4. Any file not returned in the same condition as released willreorganized by EHD st ff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $P9 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) r 1 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> LESEHD USE ONLY <br /> FXJ UNDERGROUND TANK(UST) Street Street Name City <br /> CLEANUP SITE(LOP) E]CONSUMER <br /> FXJ 1 1718 Mariposa Road Stockton <br /> OTHER CLEANUP SITE(NON-LOP) pp <br /> HAZARDOUS WASTE <br /> D/URY <br /> ❑TIERED PERMITTED FACILITY 2 1748 Mariposa Road Stockton <br /> ABOVEGROUND TANK <br /> 7 U ST (MONITORING/REMOVAL) 1,` ❑PW S <br /> HAZARDOUS MATERIALS 3 1754 Mariposa Road Stockton <br /> FXJ SPILL/RELEASE RESPONSE <br /> WATER QUALITY <br /> FXJ SOLID WASTE FACILITY/VEHI E <br /> 1 4 1796 Mariposa Road Stockton <br /> ❑FOOD FACILITY ► `� <br /> ❑POOL/SPA �f SITE MITIGATION <br /> ❑DAIRY 5 <br /> lx LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ El HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> lXJ WASTEWATER TREATMENT PLANT <br /> COPA <br /> F]HOUSING ABATEMENT 7 1 /^i J; <br /> ❑MOTEL,H OTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> ❑MEDICAL WASTE FACILITY 6 <br /> ❑TATTOO/BODY PIERCING <br /> WASTE TIRE ^\9 SOLID WASTE <br /> FXJ \\V\ <br /> COMPLAINT <br /> ❑07HER(PLEA5E SPECIFY): <br /> ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. scarf Name: <br /> Received Time—Nov, 2. -2017— 5 : 10PM—No. 2517 <br />