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2 <br /> M :Advanced GeoEnviroiFax:(707)570-1461 To: I Fax; +1 (209)464-0138 Page 1 of 1 03I11I2016 9:32 AM <br /> ���DATE RECEIVED �c ` JA� <br /> I EHD LOG NUMBER <br /> ®� K ( SAN .! UlN CC)UNTY <br /> h ,tT, ` � � ENVIRONMEN EALTH DEPARTi1.�IEN 1868 East Hazelton e, Stockton, CA 95205-6232 <br /> I 20 lephone: (209) 468-3420 Fa 9) 464-0138 Web: vwdw.sjgov.org/ehd <br /> PUBLIC RECO'RD'S RELEASE APPLICATION <br /> ,=�zlcli i r;sLt tl�lirc , <br /> APPLICANT: Jennifer Berjikian BUSINESS/AGENCY: Advanced GeoEnvirommnetal, Inc. <br /> ADDRESS: 3335 East Miraloma Avenue CITY/STATE(ZIP:Anaheim, CA 92806 <br /> PHONE (i}: 800-511-9300 PHONE(2):209-483-3401 FAX OR E-MAIL: jberjikian@advgeoenv.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> -tats will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSI NESS DAYS <br /> SIGNATURE OF AFPLECANT ::.:.:;` DATE 03/11/2016 <br /> . :..:- <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 42 <br /> 1' 747 Larch Road Tracy / <br /> U I '�() ❑ unit 1 _-4 r�` <br /> Z• 3775 N.Tracy Boulevard Tracy V <br /> 3• 3725 N.Tracy Boulevard Tracy �� ❑ Unit 2 <br /> 4. 3778 N.Tracy Boulevard ~* Tracy ElUnit 2H <br /> f 5• 3940 N.Tracy Boulevard Tacy 5-- Z Unit 3 <br /> 6. 999 Tracy Boulevardt Tracy �.�U Unit 3HM <br /> Statu ' 16850 Tracy BoulevardJuI <br /> , ,� , Tracy UA- Unit 4 <br /> $. SITE MITIGATION <br /> g, ` <br /> ❑ <br /> 'I 0. Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEUHOTEL ❑SOLID WASTE FACILITYNEHIC/LE <br /> X❑OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑ FOOD FACILITY i� IP— <br /> X❑UNDERGROUND TANK(MONITORING/REMOVAL)� ❑WASTE TIRE ❑ DAIRY,POOUSPA U(4i � <br /> X❑ABOVEGROUND TANK -4, ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE sC"t ❑MEDICAL WASTE FACILITY ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ®HAZARDOUS MATERIALS ❑TATTOoIBODY PIERCING ❑ LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Aid-5:OOP M(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)464-0138 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 END records, please contact EHD at the number noted above. <br /> 3. The EHD will notifythe 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 clays 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-END USE ONLY— <br /> ❑ Records provided by Staff-PPR Comdlete. Staff Name: <br /> Received Tiine=Mar, 11. -2016= 9; 31AM-4o, 0577 <br />