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10/28/2005 10:03 209522 <br /> GEOLOGICAL TEC110 PAGE 01/01 <br /> EHD LOG NUMBER <br /> DATE RVFNEO SAN JOAQUIN COUNTY <br /> UNVIRONA'IENTAL IUALTH DEPARTMENT <br /> 205 <br /> 2005 OCT 28 AM 9. 9 E Weber Ave 3'"8 Web::Floowww.co.san)Qa9 Stockton, uin ca.as/chd <br /> (209)468-3420 Fir (209)464-013 <br /> SAN 3OAUU11-1 000IITY <br /> L4,�, <br /> RECORDS RELEASE APPLICATIONet V}l't�rQ.SAPPLICANT: *-'t- S�O.rc. SUSINESSIAG£NCY: C t S $ p� \owl <br /> i-1N S'T -ri-xOCkQS�",o <br /> ADDRu9S: \�o <br /> PHONE: 4- <br /> a-J FACSIMILE: - -- <br /> 11 <br /> TENTATIVc APPOINTMENT DATE: <br /> (vmoc..0 w 10 busing"days from date of W11s0tion submblal) <br /> 1��p CYY1q,lRf- IO�'Y.,10 S� <br /> I� CHECK BOX TO EXPrO TE REQ 8T.$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DA'T'E <br /> SIGNATURE OF APPLICANT (�� <br /> y Daoaronem use oMr <br /> UNIT <br /> FILE ADDRESS <br /> s W . o s t 1, : 'YYw r.� F ❑ Unit 1 <br /> z ABBW . Sa +•+ s ., F Unit 2 <br /> a,b s <br /> a \o$ 9 Ga <br /> L103 I1 <br /> 7 <br /> e sraet � <br /> n <br /> Unit4 <br /> 7 6kee1 <br /> W , o w e <br /> LvO Oa O "T <br /> e. ah.a Sfi, ❑ Unit 5 <br /> e. \S\ 9. <br /> t0_ Sheet �' T'ra J • b5$ ' <br /> ENVIRONMENTAL HEALTH DEPAR i AGENT FILES <br /> ❑ SOLID WASTE FACILITY <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE VEHICLE <br /> M OTHER CLEANUP 33TE(NON-Lov) ❑ FOOD FACILITY ❑ DAIRY <br /> C UNDERGROUND TANK(MONITORIN04REMOVAL) ❑ DOG KENNEL ❑ PKO TREATMENT PLANT <br /> NAZARDoua WASTE GENERATOR ❑ CHICKEN RANCH C3 PUMPER TRUCKIyARDK:HEN TOILETS <br /> 11 TIERED pERWTTED}ACILrTY ❑ MOOLISPA EL ❑ LAND USE APPUCATK)N SITE$ <br /> DI <br /> • TATTOBOOY PIERCR40 P THE <br /> ❑ MEDICAL WASTE FACIL ❑ OTHER(PLEASE SPECIFY) <br /> T' <br /> hecking <br /> 1. List up to ten addresses In the space above. Select the types) . Fa files f theabover mall m the <br /> the appropappropriatebox(es). At least one file type MUST be selected. <br /> address indicated shove. rltrrtent for review will be corlOrnTed <br /> 2 EHD Will notify the aPplfcant if any EHD files exist An appoi sitar reCelFt application. The files <br /> apprOXIMately five business days but no later than trona ( day$�In� should be scheduled <br /> will be held for a maximum of five business days <br /> accordingly. <br /> 3. A file that Is actively being Worked on by EHD staff may Immediately <br /> y not be oval' <br /> able for review- new <br /> application may be submitted when the file I$available. <br /> 4. Any file not returned In the same condition as released�will m reorg require as d by FHD staff at the <br /> deposit prior tD� ' <br /> MO <br /> of the applicant. Future file reviews by the same app y rnQ <br /> 61 *TENTATIVE appoinbriOnt dates oust be confirmed with EHD staff. <br /> g, AppiicaWns received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> nanm, <br />