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Aug. 18, 2005 6:43PM Ad"­iced GeoEnvi ronmental - No, 1762 P. 1 <br /> t)ATE RECEIVED v �r EHD LOG NUMBER <br /> SAN JoaqulN COUNTY <br /> H E EL `,e rif,C) ENMON'MENTAL HEALTH DEPARTMENT <br /> 304 Fmt Weber Avenue,3'Floor, Stockton,CA 95202-2708 <br /> I ) 2005 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH • PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: uzanne Henderson BUSINESS/AGENCY: Advanced GeoEnvironmental,Inc, <br /> ADDRESS: 837 Shaw Road,Stockton,CA 95215 <br /> PHONE(1): 209467-1006 PHONE(2): Cell;209-712-2278 ' FACSIMILE: 209-467-1118 .- <br /> TENTATIVE*APPOINTMENT DATE: ? o'00,5— Tlme: /0'00 <br /> (Please allow 10 burin from date of appl- ion submittal--rentative only-must be confirmed) ready <br /> T1s. <br /> ® CHECK BOX TO EXPEDITE QUE $83.00 FEE(C H R CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE DS <br /> UNIT DISTRIBUTION O Untt 1 AnIt 2 41rUnit S nit 4 O Unit b f] Unit 6 0 Other(el$etronioAi$ map$) <br /> FILE ADDRESS EHD USE ONLY <br /> stre$t Street Name coy <br /> Di2 J�!410_ ST. _QCR tofu <br /> z. 1) a n <br /> 3. <br /> 4. <br /> 6. <br /> 6. <br /> 7. <br /> 8. <br /> 9. ` <br /> 10. <br /> Specific Date Range of Information Requested:F to <br /> ENVIRONME AL WEALTH DEPARTMENT FILES <br /> PQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> I4 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> W UNDERGROUND TANK(MONITORINWREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> W HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOUSPA )D LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8.00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notlfy the applicant If any EHD flies exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled 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 of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> �1 <br /> 5 <br /> EHD 4M24M <br /> 1/14= <br />