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01/11/2005 10:47 2671118 AGE STOCKTOO PAGE 02/0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN J'oAQunv COUNTYENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 R Weber Ave 3't Floor Stockton, CA 95205 <br /> .)AN 1 1 70009)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.muslehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P;-n$41j10rA\1lCF1'; <br /> APPLICANT:�NY1Y e I VCLIMn.6X-L, BUSINESsrAGENCY: Advanced GeoEnyironmental, Ina <br /> ADDRESS:_837 Shaw Road,Stockton,CA 95215 <br /> PHONE: 209-467-1006 FACSIMILE: 209-467-1118 <br /> TENTATIVE'APPOINTMENT DATE: Tare' <br /> (Pleasa allow 10 business days from data of application svomittai) <br /> CHECK BOX TO EXPEDrrE REQUE57- FEL-REQUEST PROCESSED ai 3 BUSINESS DA's <br /> SIGNATURE OF APPLICANT DATE lilt D S <br /> Deparkmnt Use Only <br /> FIL-�DDRESS� UNIT <br /> ' 9 /3 Jyirlc nad <br /> CRY <br /> ❑ Unit <br /> 2. 9o-ae <br /> aft <br /> a sre4t .0 El Unit2 <br /> 4. Stm C <br /> s. sem <br /> otw n$3 <br /> e. seeoo cn I� <br /> st� City <br /> Unit 4 <br /> B. $troet <br /> ❑ ,Unit 5 <br /> 10, CRY <br /> -J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAckrrY ❑ SOLID WASTE VEHICLE <br /> 00 UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C1 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ M07ILMOTEL ❑ PUMPER TRUCK(YARDICHEM TOILETS <br /> ❑ TATTOOISODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑ 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 appropdate box(es). At least one file type MUST be selected. F"to 1209)464-0138 or mail to the <br /> address indicated above <br /> 2. END will notify the applicant 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 behold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 1 A file that Is actively being worked on by END 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 reoroenized by FHO 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 END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONirlUtll ED A.PPOINY11' NT PATE 7IIIAE <br /> DATE(i(7NFI17MD pH014 t AJC INITIALS. <br /> Rip YES NrS !'cVllrIXTE I <br /> a72WB <br />