Laserfiche WebLink
V 01/05/2005 09:56 209467110 AGE STOCKTON PAGE 01/0 <br /> kHU Ll 9VUMpcn <br /> I. <br /> M�OT <br /> % SAN JOAQUI.N COUNTY <br /> ENVIRONIIENTA.L MA.LTII DEPARTMENT T <br /> IAN 0 5 205 304 E Weber Ave 3ra Floor Stockton,CA 95205 <br /> uin.ca.us/ehd <br /> w <br /> r �U1N ��j�68-3420 Fax: (209) 464-01.38 Web: wzv.co.sanjoaq <br /> ENVIE NMANfA1 HEALTH DEpT. <br /> PUBLIC comms RELEA E PPI,IC OTy— <br /> j� r�rjll BUSINESSIAGENCY:_Advanced GeoEnvironmental, Inc. <br /> APPLICANT: _ <br /> ADDRess:_837 Shaw Road Stockton CA 95215 <br /> -- 43 <br /> 209-467-1 FACSIMI <br /> PHONE:_ :. <br /> IVE"APPOINTMENT DATE: Q I l 4 ime: <br /> (Please allow 10 business days from date Of application submittal) <br /> ECK BOX TO EXPEDITE REQUES 93.00 FEE--REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> DATA= <br /> SIGNATURE OF APPLICANT <br /> y <br /> Department Use Only <br /> UNIT <br /> FILE AD RESS �a <br /> Cb, Unit 1 <br /> I P�U', z stbof 17 o Ca _5 <br /> ElUnit 2 <br /> 4. Sthxt C V \\ <br /> � <br /> ,y b 5. <br /> ,may <br /> �J1_: Street U� rn'1C.� ��I�tj C8 <br /> 7. Street V IS� c1 Unit R{ <br /> Q. Street C 5 <br /> — � �iif <br /> 10. Street Cif � t <br /> E <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT © SOLAR WASTE FACILITY <br /> ❑ SOLID WASt VE,HICLEk <br /> M OTHER CLEANUP SITE(NON-LOP) o FOOD rACILITY <br /> V UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> s I� CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> !L� HAZARDOUS WASTE GENERATOR C�1�© TIERED PERMITTED FACILITY 0 MOTELSAOTEL ❑ PUMPER 7RUCK/YARDICHEM TOILETSel❑ LAND USE APPLICATION SITES <br /> O TATTOO/BODY PIERCING, <br /> 0 MEDICAL WASTE FA i�Y 13 OTHER(PLEASE SPECIFY) <br /> 1. List'i1 �t�Q ter h1$dresses In the space above. Select the type(s)of files from the list above by checking <br /> t6 apprapr ate bOX(es). At least one file type MUST be sr'°ected. Fax to 209 464-0138 or Road t-0-the- <br /> - <br /> -�..._. <br /> ad els I d• al'ad above. <br /> 21 E D will notify the applinant if any END 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 files <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 EHD staff 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£HR 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 /> s. <br /> *TENTATIVE appointment data::.^ must be confirmed with EHD staff. <br /> 6. Applicatiow; v':sivod after 3:00 pm will be procassed the next business day. <br /> �O1�F1�IVl�1� - <br /> :JJ414 <br /> REVIEWED.....: ^:.. ..:YES... . <br /> . NO i :FtEVlEW1DATE � ; <br /> EHD 46-02.606 I • <br /> 8,'13I200� , <br />