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05/03/2005 13:09 2095224 GEOLOGICAL TECHN" PAGE 01/0 <br /> SAN JOAQUIN COUNTY - F"D LOG NUMBER <br /> ENVIRONWNTAL HEALTH DEPARTMENT 17 9 <br /> MAY 0 12005 304 E Weber Ave 3id Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.mus/chd <br /> ENVIRONMENT HEALTH <br /> Pf M PSERV!CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLtCANT:_�L;t•TE.eSa- BUSINEfiB/AGENCY: GtO�o a� c.w.\ Tt.cl.w:V t <br /> ADDRESS: <br /> PHONE; e, S 3�- `t 1 q FACSIMILE: 2L Cot _ S <br /> TENTATIVE"APPOINTMENT DATE: W NX f).W'Z ol- O r IGS Timm: W Ov.�S� �In+•�� <br /> _� .1-Q lT0 t 113 <br /> (PMaaa show 10 business says from date of application aubmlttaft <br /> N' <br /> ` c\w.�K w_1\ hz Y..o.•,ld s -�-v5 _ P.m. <br /> CH <br /> ECK BOX TO EXPEDITE REQUEST-$93.00 PEE-REQUEST PROCESSED IN 3 BUSINES — - <br /> SIGNATURE OF APPLICANT 0 S <br /> Aft <br /> uj3 DB95ftmem Lite OnIV <br /> Xi <br /> FILE ADDRESS uNR <br /> UST <br /> C� a Tr e ❑ Unk1 <br /> u5'f z sew 55 CDr $ L;riry Tr'..c <br /> N G suer 5`i l Gra W J- ot, Tf- r- <br /> '�v'�I�T 4 Svcs S-15 W . iA r4 _ lit2 <br /> '- jtj U5T a, sew a3"I Trw lvtl 1 rQ4 Unta <br /> us e, w.m 1540 Sm. Gcc... nq U jamb <br /> T. Se Unit 4 <br /> e. area <br /> e. D Q Unit 5 <br /> a. sre4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILEFY - 4 <br /> ■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOUP WASTE FACILITY <br /> IS OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ■ UNDERGROUND TANK(MONTORINGIREMOVAL) O DOG KENNEL 17 DAIRY <br /> • HAZARDOUS WASTE GENERATOR d CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEL,IHOTEL 11 PUMPER TRUCKIYARDICHEM TOILETS <br /> 17 TATTOOMODY PIERCING D POOLISPA d LAND USE APPLICATION SITES 6. <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY) ' <br /> 1. List up to tan 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 12091464_-0138 or mall 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 heli 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 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 /> 0. `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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EW4 <br />