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9986 'DN Wd8Z:E Slob '81 '2ny "I Pa`34 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT 017qj <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 . <br /> AUG 18 2015 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENMRONMENmi HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERVICES <br /> APPLICANT: Diane BeckeBUSINESS/AGENCY: Advanced GeoEnvironmental <br /> r <br /> ADDRESS: 3335 E. Miraloma Ave, #142 CITY/STATEIZIP: Anaheim, CA 92806 <br /> PHONE (1): 714-529-0200 PHONE (2): FACSIMILE: 714-529-0203 <br /> Please allow 10 business days from d to of application submittal for the records to be available. <br /> Staff will contact you to arrange a p ointm date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 13 F E(CA HECK ONLY)-REQUEST PROCESSED IN 3 ElLJSINqSS DAYS <br /> SIGNATURE OF APPLICANT DATE fU <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1• 1444 Tillie Lewis Drive i rk 9'T^ <br /> 91�1�s Unit <br /> 67`- 2, <br /> 3 - <br /> Unit 2 <br /> 4 ❑Unit 2H <br /> 5. <br /> 8 Ly/Unit 3 <br /> 7 _,/' N Unit 4 <br /> 8 Fy SITE MITIGATION <br /> 9. / <br /> 10. 5 Unit5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ]SOLID WASTE FACILr4YIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> �]UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> E]HAZARDOUS wASTE1HA7ARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es), At least one file type MUST be selected. Fax to(209)464-0136 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 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$130 deposit prior to review. "*BOXED AREA-EHD USE ONLY"* <br /> Eords provided by Staff-PPR COmpiete. Staff Name: <br /> EHD 4"0711115 <br /> uu Orr mnmo4mn 4 40 .15VA PPL0444RO7.L+ :XB.140XXT401aRPAnb tAn7.:01 LgOL-OLS'(LOL):XBjinnnu308gpaouenpY.� <br />