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® , 0912312015 15:49 (FAX) P.0011001 <br /> a <br /> s <br /> a � <br /> i DATE RECEIVED EHD LOQ NUME:R <br /> Ali! ,�OAC�I.�II�I (1E�1`�T`k'° <br /> ENVIRONMENTALRECENED HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> " SEP Telephone. (209) 468-3420 Fax: (209)464-0138 Web; www,sjgov.org/ehd <br /> ErWiRONW04TALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> E €IT Ile <br /> APPLICANT: Jennifer Berjikian BUSINESB/ACEI Cy-Advancsd®eoEnvlronmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:Stockton,CA 95215 <br /> PHONE (1): ZQ9-467-1006 PHONE (2): 209-483-3401 FACSIMILE: 209-467-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange n-apR °ntment date and time to review the requested records. <br /> ® CHECK BOX TO EXPEDI $130 FEE OR CHECK ONLY)-REOUEST PROCESSED IN//3��BUSINESS S <br /> SIGNATURE OF APPLICANT DATE_ 712 <br /> Electronic Information: ❑ LTr-rO Map <br /> FILE ADDRESS <br /> Street# Street Name city U E k ijY <br /> Q (� <br /> 1. 05 <br /> 2. 1,0 Unit 1 <br /> 3. 1400 VIS or Road Lodi S ty i <br /> 4, 1220 East Victor Road Lodi S Unit 2H (Q <br /> 5. 1301 East Lockford Lodi Z°" 7 - , LoIto <br /> 6. 400 North Cluff Lodi �, I��� �®(O - <br /> � 60 <br /> U <br /> 7• [D-Unk 4 <br /> 8. X SITE mrnC3AT10N <br /> 10. ❑Unit 5 <br /> Specific Date Range of Infonnatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WA87E FAcILiTYNEH1CLE <br /> +�]OTHER CLEANUP SITE(NON-LOP) ❑HOUsiv.ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MOMTORiNGIREMOVAL) ❑FOOD FACILITY ®DAiRY <br /> ❑ABOVEGROUND TANK ❑CHICCKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHA7ARDOUS MATERIALS ®MOTEL/HOTEL ❑PUMPER TRUCKIYARDiCHEMICALTOILETS <br /> ®TIERED PERMITTED FACILITY ®POOL/SPA ❑LAND USE APPLICATION SITES <br /> ®TATTOO/BODY PIERCING ❑COMPLAINTiRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RFCORDS 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 tiles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail tg tha address Indicated above, Address <br /> ranges will not be accepted.Applications received after 3:00 pan will be processed the next business day. <br /> 2. For assistance In ldentifying 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 END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appllcation. The flies will be hold 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 Ey'II id-reorgenlzed by EHD of-ff at the eXpense of the appllcant_ <br /> 'Future file reviews by the same applicant may require a$130 deposit prior to review. "�'t30XED AREA-EHD USE=oNLY"' <br /> kcporty fo r l kao ®fmI oQ, t ot LXWfjj,,k 4 O Ltji K14— V1 Vu,L0 <br /> I�ej 5 10 6 19;9turl 9 <br /> ❑ Records provided by Staff-PPR Complete. staff Name- <br /> 7E <br /> ame: <br /> E D48-06 MM <br /> Received Time Sep, 23, 2015(P 3:42PM`�Ji.o. 9 63 2 <br />