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03/08/2005 14:49 2094671118 AGE STOCKTON PAGE 01/0 <br /> [RED DA D SAN JOAQUIN COUNTY V D LOG NUMBER <br /> G YE10 ENVHiONMENTALHEALTH DEPARTMENT mos-tk <br /> 304 E Wcber Ave 3rd Floor Stockton,CA 95205 mol 1AQSe <br /> MAR 8 - 7005 (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd C4k� I, - 80u-)n <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION e0y� '1tn�d <br /> PEf�G4FpV1(;FS _ <br /> APPLICANT: Suzanne Henderson BUSINESS/AGENCY: Advanced GeoEnvironmental, Inc. - 1 <br /> ADDRESS: 837 Shaw Road Stockton CA 95215 <br /> PHONE: 209-467-1008 FACSIMILE: 209467-1118 <br /> TENTATIVE"APPOINTMENT DATE: 14 March 2005 Tima: 1000am <br /> (Passe allow 10 bunmea9 days from/data of application eubmlttol) <br /> ® CHECK BOX TO EXPEDITE REQUE - -9 .00 FEE-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE d {�,,9 " rck 000'r <br /> Depatnent Use Only <br /> FILE ADDRESS UNIT <br /> r, 6a 9898 South Jack Tone Road Stockton Unit 1 <br /> 2. seen 9970 South Jack Tone Read o Stockton 2, A <br /> a. so- 21010 South Manteca Road OW Manteca, Evans Trucking Unit 2 <br /> 4. soon 21336 South Manteca Road city Manteca *0 <br /> s. soon 21434 South Manteca Road cy Manteca 3C1UAd`7 <br /> e. sin 21710 South Manteca Road City Manteca IIIIIifUnit 3 v <br /> z sxn 21800 South Manteca Road cify Manteca nit <br /> -e. sawn 21905 South Manteca Road Gv Manteca <br /> o, So 2494 East Fremont Street cr, Stockton Unit 5 <br /> m. so-en 'Balmat&Co","Sedan Avenue" G, Manteca(only SLIC address <br /> Orphan sr`Fe) se` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES bxkc aMfp5s — <br /> R UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> PQ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL XX DAIRY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIF_RED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the <br /> address indicated above. <br /> 2. 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 irnr lately 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 /> 5. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX y INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM04eA3008 <br /> r eft <br /> MEI100d <br />