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DATE RECEIVED I `.; � EHD LOG NUMBER <br /> RECEIVED SAN JOAQUIN COUNTY 0 <br /> RECEIVED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd W <br /> ENVIRONMENTAL HEALTH PUBLIC R D@ WJP#E APPLICATION <br /> < e �� "t a# <br /> APPLICANT: Ally Colavita F BUSINESS/AGENCY: Advanced GeOEnylfonmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Stockton/CA/95215 <br /> PHONE(1): 209-467-1006 PHONE(2): 209-483-3401 FACSIMILE: 209-467-1118 <br /> TENTATIVE'APPOINTMENT DATE: ASAP Time: <br /> ��/ (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> Ill CHECK BOX TO EXPEDITE REQUEST/p-/$122 FEE(C S OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (�C�� i DATE 5- 30 -11 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street/ Street Name city L7�U itt <br /> 1. 3535 Cktvu�� SS-)arC"vl Z �l <br /> 2' t,2$ n •� y ND r nit 2 <br /> 3. <br /> 4. jo nit3 <br /> 5: bLr Moab Dir 1 <br /> 6. pe5, /g nit4 <br /> 7. .'l00 Ale W4of, I� " lln7�?7 m5l, w (Af <br /> 8. 3 300 , v ❑Unit 5 <br /> 9. 343 <br /> 10. <br /> fljj!Unit 6 <br /> Specific Date Range of Information Requested: From _ All to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES !� <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACIUTYIVEHICLE - <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> ®WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL)D( El KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR p(, ` ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY [jMOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILI-'TS I I <br /> ❑TATTOoIBODY PIERCING ❑POOIISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u0 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-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 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 /> 3. A file 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$122 deposit prior to review. <br /> END USE ONLY <br /> CO <br /> A oo - <br /> EHD 48-0e <br /> 07120110 <br />