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/ 01/05/2005 09:56 20946711. AGE STOCKTON • PAGE 01/0 <br /> tHU LUb NUrvLIPI <br /> c� �D SAN JOAQUIN COUNTY <br /> U1115W <br /> ENVIRON74ENTAL JUA.LTHDEPARTWNT <br /> IAN 5 ?%5 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> OVMENTA NEAL� 468 3420 Fax: (209)464-01.38 Wcb: WWWCO.Sanjoaquin.cams/chd <br /> O PUBLIC RECORDS RELEASE APPLICATXON <br /> - <br /> /) _ BUstNESS/AGENCY:'Advanced GEOEnvironmentel, Inc. <br /> APPLICANT: IMAlt� <br /> ADDRESS:_837 Shaw Road Stockton CA 95215 -4 �I a <br /> PHONE:_2U8.467 10 FACSIMt : <br /> m M'4 IVE"APPOINTMENT DATE: 401 i 4 <br /> - ` r (Please allow 10 business days from date Of 2pplIC81I submittal) <br /> 'OHECK BOX TO EXPEDITE REQUE3 93.00 FEE—REQLJFSTR ROCESSED IN 3 BUSINESS DAYSOF <br /> , <br /> DATE y �s— <br /> SIGNATURE OF APPLICANT Department Use Only <br /> Jun <br /> T <br /> FILE AD RESS <br /> SIF sem, rf e C Ln Unit 1 <br /> r u5 z. Ste« 17 V c 5r� <br /> HW s"9c 235 WA(E7z[tx� cn 5 �O� Vpt� U it2 \' 91 <br /> 4. S' eI - 9/ CM \ <br /> � ' <br /> 6lrxat <br /> Unit4 <br /> r3 � sve9, � � � 0 5-7—Y- CA f f p� <br /> twu CIA tltl 6UVL'It 5 <br /> 9. SVeN C <br /> CA <br /> 10, siroe� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES i a Al F� <br /> ❑ ASTE <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOL'iD WFAILITY'" <br /> ❑ SOLID WASTE-VEHICLE' ^'• l <br /> M OTHER CLEANUP SITE(NON ❑ FOOD FACILITY <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL 11 DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> W HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL 11 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOBODY PIERCING ❑ OTHERPOAOLSPA <br /> ❑ MEDICAL WASTE FA FE F ❑ OTHER(PLEASE SPECIFY) <br /> 0 <br /> I)of files from the list above by checking <br /> 1. its , te, a`"$d'resses In the space shove. Select the type( ) <br /> the <br /> th ppropnate box es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail to <br /> ad els I 'cated above. <br /> Z. 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 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 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 /> S. '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 /> COIJFIF MP-t) 4PPbih'TKiE'tJtbATE;' _ TIME <br /> DATE COMhftwti pf40NE t AX INITIALS <br /> REVIEWED r. YES :.rNO REViEW07ATE <br /> rao 4eazaae <br /> erenoo� <br />