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RECEIV . <br /> SA N.J OAQ U I N nvlronmental Health Department <br /> I . )`.. COUNTY M1AY 15, 201e, PUBLIC RECORDS RELEASE APPLICATION <br /> �It"F - Greatness grows hereEIII2. <br /> • PEflhlltT/., f IL EHD LOG NUMBER: <br /> 0%7 <br /> APPLICANT: Jackie Hyman BUSINESS/AGENCY:Advanced GeoEnvironmental <br /> ADDRESS: 3335 E.Miraloma Ave.#142 CITY/STATE/ZIP:Anaheim,CA 92806 <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 for the records to be available. <br /> Staff will contact u arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT DATE t.l may zoic <br /> 1. List up to ten addresses in th acf below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below, or email to info(a-)slcehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Q Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUMER <br /> I�Other Cleanup Site(Non-LOP) 1 13402 North Thorton Road Lodi <br /> • X-1 Hazardous Waste L"Mk%/ w` OL ❑DAIRY <br /> Q Tiered Permitted Facility 2 13436 North Thorton Road Lodi 1151fd7-"7t .. <br /> Q Aboveground Tank _). �00 "Q-1 <br /> XJ UST (Monitoring/Removal) ❑PWS <br /> Q Hazardous Materials <br /> 3 5080 West Kingdon Road Lodi <br /> �^ <br /> Q Spill/Release Response (�(�A <br /> Solid Waste Facility/Vehicle 4ATER QUALITY <br /> 5279 West Kingdon Road Lod i <br /> Food Facility <br /> Pool/Spa SITE MITIGATION <br /> Dairy 5 5285 West Kingdon Road Lodi <br /> F-]Land Use Application Sites <br /> 11 HouslNc <br /> Septic Pumper Truck/ <br /> 4895 West Kingdon Road Lodi <br /> Yard/Chemical Toilets 10, <br /> F]Wastewater Treatment Plant CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> F]Tattoo/Body Piercing ❑SOLID WASTE <br /> F]Waste Tire 9 <br /> Complaint <br /> F]Other(Please Specify): ❑AccouNTING <br /> 10 <br /> • <br /> —BOXED AREA-EHD USE ONLY <br /> Q**'E r..v ek t Pr�.e ` rTF <br /> 1 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />