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� I'VE <br /> DATE RECEIVyy,ED{ <br /> SAN JOAQUIN COUNTY � EHD LOG NUMBER <br /> R ENVIRONMENTAL HEALTH DEPARTMENT • �� <br /> 3 0 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC R D E APPLICATION �l <br /> -- <br /> APPLICANT: Ally Colavita B (NESS/AGENCY: Advanced GeoEnvironmental <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 /> Eo/ (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> L� CHECK BOX TO EXPEDITE REQUEST-$122 FEE CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L�ty%C///G DATE 5- 30 -11 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name cityU It 1 <br /> 1, 1• 3535 Cgk�_ 54-zPcvI 0 2 r��3 �a1hP <br /> 2 3425 / <br /> nit 2 <br /> 4. ? 55Li <br /> a DEJ nit3 I <br /> -6• (o(e� - - � �a�, Noce( ��� // <br /> 6. GG5 e�I <br /> Unit 4 <br /> 7. 200 1vtW401, &jo LM-IA�7A19, 111Dtor <br /> 8. 3 300 ,f <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> L. 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 FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY® MONITORINGIREMOVAL ®WASTE TIRE <br /> UNDERGROUND TANK <br /> ( )� El KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR " <br /> pC. ❑CHICKEN RANCH ®WASTEWATER TREATMENT PLANT '�7/�� <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOIL2T5 <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES (.{-1- <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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 12091464-0138 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 /> 3 5 <br /> r I <br /> n 00 , <br /> EHD de-08 <br /> 07129H0 <br />