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4 0612802011 08:30 advanced GgOlEnviromental Inc. AX)209 4671118 P.0011001 <br /> RECEIVED of SAN JOA.QUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 8 2011 600 East Main Street, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEAUM <br /> PERMIT/SERVICES PUIBLIC1 CORDS RELEASE APPLICATION <br /> APPLICANT: 1 e CV 41jA k EUSINESSiA(�ENGY: A�u�,ne ® C;�r ti�°n u. <br /> ADDRESS: S w' 9 <br /> PHONE(1):. 4�--�- Z G S 15 PHONE(2): CMZ o-►, %4 o,?In FACSIMILE. Z V 6 1^ it <br /> TENTATIVE*APPOINTMENT GATE: i�S/i _ Tim®: <br /> (Please allow to business days from date of application submittal-*Tentative only.must be confirmed) <br /> ® CHECK BOX TO EXPEDITE RE-QUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 6 <br /> SIGNATURE OF APPLICANT DATE 0b " Z 11 <br /> Electronla Informatlon: ❑ List❑ Map--Description: <br /> FiLE ADDRESS EHD USE ONLY <br /> streets Street Namo City ❑ Unit 1 <br /> itZ77-4 F <br /> 2. ❑ Unit 2 <br /> 3. Unik3 <br /> 4. <br /> 5. <br /> ❑ Unit 4 <br /> 6. <br /> 7, <br /> ❑ Unit <br /> 8. <br /> 9. <br /> ❑ unit 6 <br /> 10. <br /> Speclflc bate Range of Information Requested:From to Z ep o Z_ <br /> ENVIRONMENTALHEALTH DEPARTMENT FILES <br /> CI UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®('LOUSING ABATEMENT 0 SOLID WASTE FACiLITYNeHICLE <br /> M OTHER CLEANUP 317E(NON-LOP) la FOOD FACILITY EJ WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) t7 DOG KENNEL ❑DAIRY <br /> t� H&ARDOUS WASTE GENERATOR 13 CHICKEN RANCH 13 WA$TffWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ®MOTEUHOTEL ®PUMPER TRUCK/YARDICHEM TOILETS <br /> ®TATTOOiBODYPIERCINO 0 POOLISPA pp g�' D U�� LCAT IVES xd,► IQ��VC� <br /> ®MEDICAL.WASTE FACILITY OTHER(PLEASE SPECIFY)wPR�9 AatF �y' °� <br /> WELL AND SEPTIC PERMIT REcORPS ARE AVAILABLE FOR REVIEW - MONDAY--FRiDAY :OOPM -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)494-01813 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Appl[catlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The FHL]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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance lease contact Diane Martinez a (209)468-3425 directly. Thank You*** <br /> 71111 Li 0 <br /> 4-6 <br /> " + -. <br /> EH048•06 9/1412008 <br />