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AGE STOCKTON <br /> BATE RECEIVED PAGE <br /> E SAN JOAQUIN COUNTY <br /> EHD LOG NUMBER <br /> ''RON"ENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA, 95205 <br /> FC 3 I 2Q(P9)468-3420 Fax: (209)464-0138 Web: wwwC-O-sanjoaguin.ca,us/ehd <br /> E ' MENT HEALTH PUBLIC RECORDS <br /> APERMiT RELEASE APPLICATION <br /> PPLICANT:, tJZQ n <br /> BUSINESSIAGENCY: Advanced GeoEnvironmentat, Inc. <br /> ADDRESS:_837 Shaw Road,Stockton,CA 95215 <br /> PHONE:_209-467-1006 <br /> -__FACSIMILE; 209-467-1118 <br /> TENTATIVE*APPOINTMENT DATE: <br /> Tuna- <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUE3 3.00 FEE—REQU TPR CE$SED IN 3 BUSINESS �, <br /> SIGNATURE OF APPLICANT DAYS 7han� <br /> DATE <br /> FILE ADDR S DePart ment Use Only <br /> �. saaec <br /> 2 Strerx UNIT <br /> a. s"'"' ❑ Unit 1 <br /> ❑ Unit 2 <br /> e. s c <br /> 7. saner C° Unit 3 <br /> a. 3trne� Ci <br /> s SDbo1 Unit 4 <br /> c" ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )C UNDERGROUND TANK(UST)CLEANUP SITE LOP ❑ <br /> �r OTHER CLEANUP SITE(NON-LOP) ( ) C3 FOOD HOUSINp ABATEMENTUNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE FACILITY <br /> HAZARDOUS WASTE GENERATOR ❑ SOLID WASTE VEHICLE <br /> TIERED PERMITTED FACILITY D CHICKEN RANCH 13 DAIRY <br /> TATTOO/BODY PIERCING 2 MOTEL/HOTEL ❑ PKG TREATMENT PLANT <br /> ❑ MEDICAL WASTE FACILITY ❑ POOL/SPA a PUMPER TRUG"ARDYCHEM TOfLETS <br /> O OTHER(PLEASE SPECIFY) ❑ LAND USE APPLICATION SITES <br /> List up to ten addresses 1n the space above, Select the <br /> the appropriate bOX(es). At least one file tYpe(s)of files frons the list above by Checking <br /> address indica+@d above type MUST be selected. Fax to(209)464-0138 or mail to the <br /> Z• EHD wtt(notify the applicant if any EHD files exlsL An appointment <br /> approximately five business days but no later than ten(10)days after receipt of application. The fil <br /> will be held for a maximum of flue business da s for reve�, Afor review will be confirmed <br /> accordingly, Y ppointments should be scheduled es <br /> 3• A file that is actively Mein <br /> g worked on by application may be submitted when the file FisDaval abMay le. be <br /> 4. Any file not returned in the same Condition as released Nfilltbe reorganized <br /> available for review, <br /> A new <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior <br /> '• 'TENTg7'l�a g ed by EHD staff at the expense <br /> G. appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> P to review. <br /> �OdVFI M .................N`MENt p <br /> DA, ;,Tj <br /> .NF1 <br /> r�i• <br /> K .� <br /> R _ <br /> L"\ <br /> 1`7• .. .:it's•4 <br /> ED <br /> W. <br /> E -0HD <br /> U O'• - <br /> 6'a/ <br /> 700.7 - c[f:•�•• _. ..,. <br />