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-NEI! <br />03/17/2005 14:11 2094671118 <br />17 <br />Ask <br />go EHD LOG NUMBER <br />'MED SANJOAQUINCOUNTY <br />ENMONMENTAL HEALTH ]UPARTNEENT <br />3p4 E Weber Ave 3d Floor Stockton, CA 95205 <br />MIAR 1 7 70009) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquiji.ca.us/ehd <br />ENV{RONNAIENT HEALTH <br />..,T,r� „Irc� PIT LIC CORDS LF,ASE PLICA <br />PER <br />APPLICANT: <br />..31 <br />95215 <br />BUSINESWAI3ENCY:.Advanced GeoEnvimnmental, Inc,_____ <br />PHONE: _ 209-467^1006 FACSIMILE: — cTIM r - v <br />TENTATIVE" APPOINTMENT DATE: , e�DOS"Time: <br />(Please allow 10 business der from data of applloWan subMlttpl) <br />CHECK BOX TO EXPEDITE REQU 93.00 FEE – REQUEST F ESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT NT ®ATE <br />Department Use ONY <br />ENVIRONMENTAL HEALTH DEPA144ANEMUILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT A OLID . VEHICLE <br />CILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />LE <br />VIL UNDERGROUND TANK (MONrrORING/REMOVAL) 0 DOG KENNEL ® DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOO/60DY PIFAOING Q POOLISPA ® LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of tiles from the list above by checking <br />,the appropriate boxes). At least one file type MUST be selected. G9Y to (2 094 464^0138 or ma1'I to the <br />address indicated above. <br />2. EHD will notify the applicant If any EHD les exist, An appointment for review will be confirmed <br />approximately five business days but n later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five busin ss days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that is actively being worked on b EHD staff may not be Immediately available for review. A new <br />application may be submitted when the le is available. <br />4. Any file not returned In the same conditi n as released will be reorganized by EHD Staff at the expense <br />of the applicant. Future file reviews by t e 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 a processed the next business day. <br />