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12/16/2004 14:50 2094E AGE STOCKTON PAGE 01/0 <br /> EHD LOG NUMBER <br /> ATEREqEIVED <br /> SAN JOAQUIN COUNTY <br /> ENVIRONWNTAL HEALTH DF-PARTNUENT <br /> DEC, 16 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 /ebd <br /> . (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.lus <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> _1 � 41WY�_ USINESVAGENCy: Advanced GeoEnvironmental,Inc. <br /> r � <br /> ADDRESS:_837 Shaw Road�Sto o�n/A95215__ <br /> PHONE:_209-467-1006 FACSIMILE:_209467-1118 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 1c business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PRO ED INNUSINES$DAYS DATE <br /> SIGNATURE OF APPLICANT <br /> DePartrr*nt Use Only <br /> FILE ADDRESS UNIT <br /> 1. Strw 11" Unit 1 <br /> 2. Eb-pat <br /> A J2 I <br /> Lk 5 <br /> N41*V seeet a0l AN im 909 CA—. C3 Unit <br /> city <br /> a. stat Chy nn ON onnaCiUnit 3 <br /> ty <br /> 6. Met iin 11 I'l "D <br /> %V%VUWWU -F <br /> 7. Stunt cftv Unit 4 <br /> a. swat City <br /> 9. S"et _CAy ❑ Unit 5 <br /> 10. Sfrtet <br /> C4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORiNGIRF-MOVAL) 13 DOG KENNEL 0 DAIRY <br /> M HAZARDOUS WASTT;GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY C3 MOTEL/HOTEL E3 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 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(2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The flies <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 El'Ibstaff may not be immediately available for review. A new <br /> application may be 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 <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED'APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> L4 <br /> �Yi 4aq, <br /> a _S,C t C11 <br />