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0310612015 15:05 46. ) <br />P.0011001 <br />W.G&VED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />MAR 0 9 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL HEA phone: (209) 468-3420 Pax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PERMIT/SERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Jennifer Belikian BUSINESS/AGENCY:Advanced GeoEnvironmental <br />ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton, California 96215 <br />PHONE (1): 209-483-3401 PHONE (2): 209-467-1006 FACSIMILE: 209-467-1118 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 busl7s days f to of application submittal - "Tentadva only - must be confirmed) <br />E] CHECK BOX TO EXPED Em5125 FEE ( H OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINES W <br />SIGNATURE OF APPLICAN DATE i � <br />Electronic Information: ❑ Lls Map — D riptlon: <br />PILE ADDRESS EHD Use ONLY <br />Street 0 Street Name City <br />Unit 1 <br />1. 1730 <br />Ackerman Drive Lodi <br />2. 1702 <br />3. 1725 <br />�/ <br />�Jntt z <br />Ackerman Drive Lodi <br />Ackerman Street Lodi <br />1.I wgvH� ti.. -v ql <br />/1-7 <br />l) 4' <br />-vet <br />Unit 3 <br />-� 6. <br />R'�d b� , rin <br />UnIt4 <br />7. <br />L1) 11 <br />8° <br />cM <br />Unit 5 <br />Specilla Date Range of inforn-mdon Requested: From a I I to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br />x❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ® WASTE TIRE <br />® UNDERGROUND TANK (MomTORING/REMOVAL) ❑ DOG KENNEL ® DAIRY <br />® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />® TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PWPERTRUCK/YARWCHERCALTOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ® LAND USEAPPi1CAnoN SITES <br />❑ MEDICAL WASTE FACILITY ® COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PSFUT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5.00PM (EXCLUDING HOLIDAYS) <br />1. Li$t up to teen addresses In the apace 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 (2091464-0136 or mail to the address indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, Contact the EHD, Applications received after <br />3:00 pm will. be processed the next business day. <br />2. The EHD will notify the applicant if any END flies exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files vAll be held for a maximum of five business days for review., Appointments <br />should be scheduled accordingly. <br />J <br />3. Afile that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file Is available. <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 $125 deposit prior to review. <br />E <br />Received Time Mar. 6. 2015 3:04PM No,8279 <br />