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❑ New Facility ❑ Existing Facility San Joaquin County Environmental Health Department Application Form Facility Name Applied Aerospace Structures Corporation Site Address 3457 South Airport Way city Stockton State CA ZIP 95206 APN Supervisor District T pe of service ❑Application for ❑Consultation ❑Change of Owner ❑Repairs or Remodel 0 Other Requested Operating Permit Comments If mobile food truck or License Plate Number VIN pumper truck Contact Types ❑Billing Party ❑Facility Owner ❑Facility Contact ❑Property Owner ❑Contractor ❑Architect required 2 Billing Party ❑Facility Owner::JL namcContact ❑Property Owner ❑Contractor ❑Architect First Name Casey e Sanders If contractor,indicate type and license number Address 2020 L Street, Suite 300 city Sacramento State CA ZIP 95811 Phone Phone Email t 916-223-8641T sey.sanders@aecom.co fie�'`-�r/`r ❑Billing Party 0 Facility Owner ❑Facility Contact ❑Property Owner ❑Contractor ❑Architect First Name Gardena Holdings Inc. Last name If contractor,indicate type and license number Address 201 Helios Way City Houston State TX ZIP 77079 Phone Phone Email 916-223-8641 Casey.sanders@aecom.co ❑Billing Party ❑Facility Owner ❑Facility Contact ❑Property Owner 0 Contract tnPrOD ❑Architect First Name Dennis Last name Ott If contractor,indicate type and license number C-57 1012248 Address Roseville city Roseville State CA ZIP 77079 Poe Phone Email ('590)-693-021 BILLING ACKNOWLEDGEMENT:I,the undersigned property or business owner,operator or authorized agent of same,acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this form. I also certify that I have prepared this application and that the work to be performed will be done in a�C ycordance with all SAN JOAQUIN COUNTY Ordinance Codes, Standards,STATE and FEDEF ' ' (Attorney in fact for Gardena Holdings Inc.) 09/10/2024 APPLICANT'S SIGNATURE: _ DATE: ❑PROPERTY/BUSINESS OWNER 2 OPERATOR/MANAGER ❑OTHER AUTHORIZED AGENT Title If APPLICANT is not the BILLING PARTY,proof of authorization to sign is required t _4f AUTHORIZATION TO RELEASE INFORMATION:When applicable,I,the owner or operator of the property located at the above lite address,hereby authorize the release of any and all results,geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. rs Accepted By Assigned To % LAG/ Linked FA ID i J Date ��I Fee Record Number A Payment ❑Cash ❑Check# confirmation# 13 Z 0 h s Received By Rev 07/10/2024