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ao 1212212015 12:00 (FAX) P.0011001 <br /> !1, <br /> RECE]VED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DSC 2 911a 1668 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: JenniferSeriikian BU SIN ESSIAGENCYAdvanced GeoEnvironmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton, CA 95215 <br /> PHONE (1): 209-467-1006 PHONE FAX OR E-MAIL: 209487-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQU - 11. _(CASH OR. HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 12/22/2015 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street 0 Street Name City <br /> 1. 415 West Yosemite Avenue Manteca <br /> 2 [jUnit 1 <br /> 3. ❑Unit 2 <br /> 4. ❑Unit 2H <br /> S. E6Unit3 <br /> • 6. <br /> ❑Unlf SHIM <br /> 7. dtfnit4 <br /> 8. MAITE MITIGATION <br /> 9. <br /> ❑Unit a <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEUHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> ®UNDERGROUND TANK(NlowrORINGIREMOVAL) ❑WASTETIRE ❑DAIRY,POOLISPA <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCW DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY L]PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMrrrED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEFTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Llet up to ten addresses In the space above. Select the type(s)of flies from the Hot above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(2D9)484-0138 or mall 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 flies exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will behold 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. <br /> • "*BOXED AREA-EHD USE ONLY'•' <br /> E3 Records provided by Staff-PPR Complete. Staff Name: <br /> Received Tlme Dec, 22, 2015 11 : 51AM U. 0244 <br />