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1 <br /> 01/05/2005 04:56 20941---".18 AGE STOCKTON f PAGE 01/0 <br /> nn EFtU LU>la NVIVID P, <br /> SA,NJOAQUTN Co>Erlvey <br /> EwmoNmENT`AT,HE, DEPA RTiv� IM <br /> AN � 5 2.445 304 E Weber Avg 3'�Floor Stockton,CA 95205 <br /> 68-3420 Fax: (209)464-01.38 Web:www.eo.sanjoaquin-cams/chd <br /> SAV4N0 <br /> F�AI)EP <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: c�tn/l� _Q EUSlNE551AGENCY:_ <br /> Advanced GeoE.nvironmental. Inc. i <br /> ADDRESS:_837 Shaw Road Stockton CA 95215 <br /> PHONE: 209-467.1006 FACSIMILE: 209-467-1118 _ <br /> TENI'ATNF-'°APPOINTMENT DATE: Timec <br /> a <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK SOX TO EXPEDITE REQUES 93.00 FEE—REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> f <br /> Department Use Only <br /> FILE AD RM UNIT <br /> -Rotc LD ❑ Unit 1 <br /> 2. 17 5 <br /> ;Z'3 S 0 6V4M?ek.0V c S M]�- f ❑ Unit 2 <br /> 4• Street G <br /> -�a M4 <br /> 7. Street r � `� a i.p U it Rl <br /> s. stt�,t 2 <br /> 9. str"t G ❑ Unit 5 <br /> 10. sweet G' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ASATEMVNT © SOLID WASTE FACILITY <br /> * OTHER CLEANUP srrE(NON.LOP) 10 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> * UNDERGROUND TANK(MONITORINGIREMOVAL) 0-DOG KENNEL ❑ DAIRY <br /> * HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY 10 MOTELrHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICATATTOOL <br /> WAS3ODY PIERCING ❑ OTHER PLEASE SPECIFY) <br /> C1 IVIEp.CAL WASTr_FACILITY { - <br /> 1. List up to ten addresses In the space-above.:Select the t;ypets) of files from the list labove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 249 464-0138 or mail tot e <br /> address 9ti>dicated above. <br /> 2, EHD wii(.notify the`applicant-if:any EHD files exist, An appointment for review will be confirmed <br /> approximately five business days but no later than torn(10)days after receipt of application. The files <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available far review. Anew <br /> application may be submitted when the fife is available. f ; <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> a. Applications received after 3:00 pix:will be processed the next business day. <br /> i ' <br /> t O'C�l�1Fi�lV'I�Cf�,P��i�I�Tivi�t+l�`'�'A:T'�:' __ - _"��IfE: • -- _ s;�:. . ��.�.�.�:;: . . , <br /> atouIFlFrll ;PF1CilE::: :Y( ': =INI'lL'S <br /> E .CVir`°f3 .AYE <br /> R VI 'I~ <br /> CHI)4a-0i;roe' <br /> ararxooa <br /> A, <br />