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1111012015 15:27 "'��) P.0011001 <br /> � , AE� �'QAQt�lt� E3EJFiT'�' E€IDLac�ritJr��ER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> tt` , 0V j (� 71�'��� _ � 1868 East Hazelton Avenue, Stockton, CA 05205-6232 <br /> Telephone: (200)468-3420 Flax: (209)464-0133VVeb.www.sigov.org/ehd <br /> JAL <br /> FArr"I—L7 n ra,M^n <br /> PUBLIC RECORDS RELEASE APPLICAMN <br /> APPLICANT: Jennifer Beriiklan BUSIFNESS/AGEr4CY:Advanced GecEnvironmsntal ®` <br /> ADE?I'ESS: 837 Show Rood CITYi8TA E/,Mp:Stockton,CA 95215 _r6 r <br /> PHONE(1): 209-467-1006 PHONE (2): 200-483-3401 FACSIMILE:209-467-111;q /W <br /> Please allow 10 business days from date of application submittal for the records to be available. Colo) <br /> Staff will contact you to arrange an appointment date and time to revises the roguosted records. <br /> ❑CHECK BOX TO EXPEDITE= UE -$130 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3USINESS DAYS <br /> SIGIEATURE OF APPLICAN DATE <br /> Electronic information: ❑ List Map—i]escrlption: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> ri 213 South Kelily r I cjvj <br /> v214 South Felly Lodi <br /> Unit 1 <br /> 224 South KellyC LDdi <br /> El <br /> -Unit e" <br /> 4. 77 South Cluff Lodi Ej Llnit 2tt <br /> 851 East Lodi Avenue Lalli j (2 <br /> p•rVEnit s <br /> p-UnR 4 <br /> �' 1-1.C/trc nrtmnn�nn� <br /> 10. [ti Unit <br /> Specific Date Range of Information Requested: Frorn _ _ to <br /> s j ENVIRONME14TAL HEALTH DEPARTMENT FILES <br /> [q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE /0 <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEIBE=NT ❑WASTE TIRE <br /> 0�JNDERGP,OUND TANK(MONrroP.IN31REMOVAL) ❑F000 FACILITY ❑EIAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/Doc KENNEL []'WASTEWATER TnEATNIENT PLANT <br /> EJ AWARDOUS WASTEIHAZARDOUS I`J'iATERIALS ❑MOTELIHOTEL ❑PUr4PER TRIJOWYAWCHEMICAL TOILETS <br /> Q TIERED PERIArrTED FACILITY Q POOLISPA ❑,(A}tb USE APPLICATION SITES <br /> ❑TATTOO/800Y PiERCiNG Q Cof�PLAINITIRESP6h5E RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Ahi-5:0015M(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MOIST 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 EHG 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 EHE)staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit Prior to review. IBOXED AREA-EHD t1SE ONLY' <br /> I����C;•E=rl--'1 '%,�} I l l j i''i v I�1�./%!);��:.'�� �.`i{'!iii'(i'l i��i-.1_ `/r�- r\///��. ,1 y r 1�✓'�;{� \'.` <br /> ❑ Records provided by Staff-PPR Complete. St7-ff Name: <br /> EHD 48.08 <br /> 7!1!16 <br />