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- <br />RI GEOTECHNICAL <br />120/2005 15:01 916-371-7 D <br />p� <br />. F140roc NlNu18ER <br />4 2005 _ <br />SAN_JOAQU1N CovF�X_— - -- - c�Z HEA�jN <br />,)ATF RECEIVED EPARTYX� <br />� <br />- - n"ENTAL $EALTS �. <br />3`d F'looT, Stocl�ton> CA 95242-270$ ENV1RDiJ <br />ani F'.agt WP-beT Avenin, �^ a jAA._01'A8 Web: WW SJgcv.org/ehd <br />Phone. (20�)ku�-,4_U ra.x.: �1 cJ,� _ <br />F RELEASE APPLICATION <br />PLIC RL+ CORDS �Zau.e CLQ o tc �� <br />gUs1NESS(AQENCY: <br />Cp <br />gppLICANT: W� C b <br />Q.aGo FACSIMILJ:L <br />D (�B<4� <br />ApDReSS: is <br />PHONE <br />(z)= <br />PHONE (1) RTettteb1/s only must ba eonftrmfld) <br />TENTATIVE'` APPOINTMENT DATE: of aPPll subMI I - <br />(Please ailow 10 bu9lness days "I dab CHECK ONI-711-MQUEST PROCESSED IN 3 BUSINESS DAA <br />r . se cases OR DATE �a zp� <br />❑ CHECK 13Ox To EXPEDITE RE j3j <br />❑ Units t3 Unit 6 0 Od'1er (electrnnl�latahnaps) <br />SIGNATURE OF APPLICANT C _ <br />O unit ntt 3 Unk 4 j <br />❑ unnl ) <br />UNITDISTRIau1fON l;H USE ONLY <br />FILE AD_ DRESS -- —T cny , <br />street _.. — '[�• <br />u 1-rfir"- <br />vUSi+( 2.3. <br />j UST N 4. `2 CTYRn <br />uST H _.. - <br />6. — _---- <br />7. <br />to <br />speCific Date Range of Information fteyuestc-d:Froin - EPARTNIENT FILCIS '� s <br />ENVIRONMENTAL HEAL - <br />0 SOLID WASTE FACtI rIY1�1EN E <br />❑ HousTNe ABATEMENT ❑ wAsTE TIRE <br />NDER6ii0UND TANK (UST) CLEANUP SITE (I -QP) 0 FOOD FACILITY <br />0 DAIRY <br />OTHER CLEANUP SITE (NON -LOP) r l Do* KENNEL M WASTEWATER TREATMENT PLANT ^.. <br />UND.R%ROUND TANK(MOMMOFtlNGlReuOVwLj CHICKEN RANCH U1 <br />HAZARDOUS WA GENERATOR ❑ pUMPERTRUCKi`(ARDICHEMTOIL7"Ts <br />❑ MoTELMOTEL ❑ LAND USE APPLICATION SITES <br />,TIERED pERMITTED FACtl-TIY rl POWSPA <br />0 TATT0018013Y PIEROINQ D oTNER(PI.FASESPECIPY) <br />D MEIi1GAI WASTE FACILrIY ONLAY -FRIDAY 5.00 AM_6,00PM EXGLUDn+G HoLtbAY9. <br />WELL AND SEPTIC PERFIIT RFCO�S ARE AVhNABtE FOR REVIEW - e s files from the Iist above by Checking the <br />1. List Up to ten addresses in the space apov®. Select fibs ct () -0138 or m to the addres <br />appropriate box(es). At least one.flle type MUST be selected. to 209 <br />Indicated above. Address ranges will not be accepted I Q�®ssedditional assistance the next business day files addresses, contact <br />4h� GI In ennlic�tions received after $:afl prr► w p ho confirmed <br />2. The EHD will not:f•,7 the af•, -Arlt it any EHO tiles ®xISL HII appoixs�:,�••..•..• <br />approximately ten (10) days after receipt of application. The files will be held for a whaXlmum of five nuslness <br />days fol, review. Appointments should be scheduled accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br />application may be submitted when the file is available. <br />4. Any file not returr:3' In t" eannw f-Onditlon as released will be reorganized by EHW staff at the expense of the <br />•..... ,...,<a� -....e anplimnt may require a $93.00 dej�rrsit prior to MAW <br />END 4e-02-006 <br />1114MS <br />