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03/08/2005 14:49 2094671118 AGE STOCKTON PAGE 01/0 MAR ' 7005 3041✓ Weber Ave 3 Floor Stockton, CA 95205 lease (209) 468-3420 Fax: (209) 464-013$ Web: www.co.san-joaquin.ca.us/ehd Cctl� J. 8()U) n ENVIRONMENT HEALTH LIC RECORDS RELEASE APPLICATION SOV PE ES APPLICANT: Suzanne Henderson BUSINESS/AGENCY: Advanced GaoEnvironmantal, Ina -1W H ADDRESS: 837 Shaw Road, Stockton CA 95215 PHONE: 209-467.-1006 FACSIMILE: 209-467-1118 TENTATIVE* APPOINTMENT DATE: 14 March 2005 Time: 10:00am 10A (Plaaaa allow 10 business days from date of application eubmWal) AAAD EJ CHECK BOX TO EXPEDITE f SIGNATURE OF APPLICANT FILE 14 1, saw 9898 South Jack Tone Road Z. svw 9970 South Jack Tone Road 21.010 South Manteca Road w y 1 3 BUSINESS DAYS Stockton Stockton w 4. suve 21336 South Manteca Road m, Manteca - RECEIVED s. seem 21434 South Manteca Road , , , e r� • s, sac 21710 South Manteca Road o Manteca ri`lr r. sftm 21800 South Manteca Road Manteca NI F MAR ' 7005 3041✓ Weber Ave 3 Floor Stockton, CA 95205 lease (209) 468-3420 Fax: (209) 464-013$ Web: www.co.san-joaquin.ca.us/ehd Cctl� J. 8()U) n ENVIRONMENT HEALTH LIC RECORDS RELEASE APPLICATION SOV PE ES APPLICANT: Suzanne Henderson BUSINESS/AGENCY: Advanced GaoEnvironmantal, Ina -1W H ADDRESS: 837 Shaw Road, Stockton CA 95215 PHONE: 209-467.-1006 FACSIMILE: 209-467-1118 TENTATIVE* APPOINTMENT DATE: 14 March 2005 Time: 10:00am 10A (Plaaaa allow 10 business days from date of application eubmWal) AAAD EJ CHECK BOX TO EXPEDITE f SIGNATURE OF APPLICANT FILE 14 1, saw 9898 South Jack Tone Road Z. svw 9970 South Jack Tone Road 21.010 South Manteca Road w y 1 3 BUSINESS DAYS Stockton Stockton w 4. suve 21336 South Manteca Road m, Manteca r� s. seem 21434 South Manteca Road egy Manteca ^°1'= s, sac 21710 South Manteca Road o Manteca ri`lr r. sftm 21800 South Manteca Road Manteca NI F & ami 21908 South Manteca Road Manteca v j �'.� p s T - 1A 2494 East Fremont Street ft Stockton 1o. sees: "Balmat & Co", "Sedan Avenue" ck„ Manteca Evans Department Use Only UNIT ❑ Unit 1 2 *Unit itORO nit 4 ❑ Unit 5 D 72110104 3�5 ®t�Q'I`n han StTe, ENVIRONMENTAL HEALTH DEPARTMENT FILES vu,t:► amr css --- 0 0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY IQ OTHER CLEANUP SITE (RON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE 10 UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL X( DAIRY RJ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILM ❑ TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. fist up to ten addresses in the space above, Select the type(s) of flies from the list above by checking the appropriate box(es). At least one file type MUST be selected, Fax to 209 38 or mail to the address iadicated above 2. EMD will noft the applicant If any EHD flies exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file I$ available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense Of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review, 61 *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS ` REVIEWED YES NO REVIEW DATE 4 3'