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01/14/2004 07:32 2095224227 GEOLOGICAL TECHNICS PAGE 01/E <br /> Ub/LC/'LU04 1/:Ul 4b4U138 ENVIRONMENTAL HEAT TH - PAGE 01 <br /> SAN JOQUIN COUNTY <br /> U�l EA MWED ENVIRON ENTALHEALTH DEPARTMENT <br /> JAN 1 4 2004 304 EAST WEBER AVENUE,THIRD FLOOR /— <br /> STOCKTON CA 96202 <br /> (208)46 <br /> ENP RONM iffls�ERWGEE PUBLIC RECORDS RELEASE APPLICATION <br /> a J Cts <br /> APPLICANT M( c\.a"e C. C.O'�'F C U8wESZENCY,_,G '��\oy' <br /> (ADDRESS \��\ �k� - 4S a C 5 3 5 <br /> 'PHONE -L'30\ FACSIMILE <br /> D AP sr.d S o.� <br /> TENTATIVE"APPOINTMENT DATE £'.\zc AJC\�h\\� TIME <br /> give 7 to 10 businem do"from data of applilo"eft <br /> CHECK BOX TO EXPEDITE REOUE9 D <br /> -W9,DO FEE REOUEST PROCESSED IN 3 BUSINESS DAN ) <br /> SUA _ <br /> 1SIGNATURE OF APPLICANT DATE ( 1 <br /> S IDE EHD STAFF USE ONLY <br /> PILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> i <br /> � v <br /> ENVIRONMENTAL HEALTH DIVISION FILES ' <br /> a UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP BITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IS UNDERGROUND TANK(MONITORING)REMOVAL-) O DOG KENNEL ❑ DAIRY -, <br /> '* HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑ MOTELINOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTOOIBODY PEIRCINO O POOLISPA - O LAND USE APPLICATION SITGS <br /> ❑ MKOICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to tan addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate boX(es). At least one file type MUST be selected. Fax to(20914640138 or mail to the <br /> address indl 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 aPP001110en. 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 Immediately avallable 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 Se9.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g, Applications received after 3:00 pm will he processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> z*W= <br />