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01/05/2005 09:56 2094F--118 AGE STOCKTON PAGE 01/0 <br /> EHU LIX�rvuovlPcn <br /> SAN.�O.�Qv1►N COUNTY <br /> SAN t1 5 2.045 304 E Weber Ave 3`d Floor Stockton,CA 95205 , <br /> QUiN C&IN)A6T•8-3420 Fah: (209)464-01.38 Web:Vy-WW.c0.Sa11-Joaqum-ca.us/chd.,TC R,rj CORDS RELEASE APPLICAVON <br /> SW <br /> ENViF NMENTAL HEAL-f H DEP <br /> APPLICANT:_ 'I�QAftQ_T �� BUSINESSIAGENCY: Advanced GeoEnvironmental,Inc. <br /> ADDRESS:_.837 Shaw Road Stockton CA 95215 <br /> PHONE: 209467-1006 FACSIMILE:_209-467-1118 / <br /> TENTATIVAPPOINTMENT DATE: Tama: <br /> E' <br /> (Please allow 10 business days from date of application submittal) <br /> C <br /> u CHECK BOX TO EXPEDITE REQUES 93.00 FEE--REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> DATESIGNATURE OF APPLICANT <br /> J y <br /> Department Use Only <br /> UNIT <br /> FILE A13RESS <br /> s rie Rd 40 � �p ❑ Unit 1 <br /> s. street 2 3.S W � a e 5 rt E] Unit 2 <br /> c1tv \� <br /> 4. stmet 5_i— <br /> s. e � / <br /> 6. Strot,t <br /> >t <br /> S 4 Unit A <br /> _ - <br /> e. s 2 1 <br /> 9 s��t c ❑CR Unit 5 <br /> C:* <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [3C3 SOLID WASTE FACILITY HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> N OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TFtEATf:IENT PLANT <br /> M HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ pooL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PIERCING <br /> O MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 9. List up to ten addresses In the space above. Select the type(s)of files from the?ist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)4V Gi 38 or mail to RP_>e <br /> address Ind' ted y for review will be confirmed <br /> EHD will notify the applicant if an EHD files exist. Anappointment <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 /> ;t. 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 /> 6. "TENTATIVE appointment dates must be confirmed with EHD staff. . <br /> 6. Applications received after 3:00 pm will be procassod the next business day. <br /> cN't- Miorpoi <br /> =.j NI7:f7�L5 .. <br /> . ATE;' <br /> REI�IEVd�D:..... <br /> I� 11>'1 <br /> 4 <br /> LNO 4w-0Z4108 <br /> EYJYlt10� <br />