Laserfiche WebLink
PAUE b 1 J U <br /> 03/17/2005 14:11 2094671118 AGE STOCKT I <br /> EHO LOG NUMBER <br /> MMf� SAN JOAQ COUNTY <br /> ED ENVIRONMENTAL AL'TH lE PAR"IENZ' q6 <br /> 304�Weber Ave 3'd Floor Stockton,CA 95205 <br /> M-1.AR 1 7 X00009)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH )PCJ LIC RIECORDS RELEASE APPLICATION <br /> P � <br /> APPLICANT: BUSINESSIAGENCY._Advanced GeoEnvimnmental,Ina <br /> ADDRESS:_ <br /> 887 Shaw Road,_Stockton,CA95215 c <br /> PHONE:�209-4671006 _ FACSIMILE: 209467-1118G, <br /> 44— <br /> TENTATIVE"APPOINTMENT DATE:, <br /> (Pleas®allow 10 bush""days from date of applicatlon subrttWI) <br /> CHECK BOX TO EXPEDITE REQUE 93.00 FEE—REQUEST PPjOCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . ®ATE <br /> Department Use ONY <br /> FILE ADDRESS UNIT <br /> 1 Ssl ❑ Unit 1 <br /> 2. street <br /> a0 <br /> Mw <br /> A. SUVA l <br /> 9 tmo! <br /> 8. Street <br /> 7. Stoat <br /> 8. Stmol <br /> e. [�~ "Unit 5 <br /> west <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEP A1E T ILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT E`ft WASTE FACILITY <br /> Ir <br /> 1K'. OTHER CLEANUP SITE(NON-LOP) d FOOD FACILITY LI SOLID WASTE VEHICLE <br /> ¢� UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ® DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ NOTELIHOTEL O PUMPER TRUCKIYARDIC HEM TOILETS <br /> ❑ TATTOO/BODY PIERCING C3POOLISPA C3 LAND USE APPLICATION SITES <br /> ❑ MEDiCAL WASTE FACILITY ® OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by Checking <br /> .the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD les exist, An appointment for review will be confirmed <br /> approximately five business days but n later than ten(10)days after receipt of application. The files <br /> Will be held for a maximum of five bush ss days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on b EHD staff may not be immediately available for review. A new <br /> application may be submitted when the le is available. <br /> 4. Any file not returned In the same conditi n as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by t e sang applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 61 Applications received after 3:00 pm will a processed the next business day. <br /> ppJJqq .�6` LLa �y ��,Iyy�Wy,,II,.yy��yy�±y++s■��CCl1,� ''i!,1,11YICn, .I;�_ vrz'.,.- .:•. <br /> V'ti;7 i�AR1Yt�V�'AI?i',tJ1l�niir{hiiV: I..•:I <br /> Ixx.r..x• r :i . `y <br /> . ....._. ...mu•:r.r' A.AY: ':".rte <br /> 1''I✓VI.1 <br /> -'•... :k1, NE,�d •'FA'X,. <br /> _ r...i ...:..a._. :... ... ..,x :. : i is•x••..•'+ <br /> YES <br /> .,...x. x..: +a <br /> x. .. <br /> EHD 49.02-0OG <br />