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m10/28/2005 10:03 209522 GEOLOGICAL TEC2 PAGE 01/01 <br /> EHE)LOG NUMBER <br /> DATEREMPIED SAN JOAQUIN COUNTY <br /> ,,.NVIHONMENTAL HEALTH DEPARTMENT <br /> 2005 OCT 28 AM Nix:a Weber Ave 3`" Floor Stockton,CA 95205 <br /> (2o9)468-3420 Ftii: (209)464 0138 Wets:www.co.san joaqu •�•uslebd <br /> SAN lOhaujth COUNTY <br /> ENYIROym. RECORDS RELEASE APPLICATION <br /> ' a� �LiC.1J4wR <br /> .ntGtV �\tC-\-,— . BUSINESSIAGENCY. e <br /> APPLICANT! <br /> 9 S S S <br /> ApOR-nSS: ��Q <br /> PHONE: <br /> a 0°� S ? G71,\ { FACSIMILE: O 9 5 1� <br /> TENTATIVE APPOINTmFXT D �� 1l-L D 5 ATE: L •� Tom" a L ' <br /> Ivlaaw Uow to basins"Ba"frown dam or®PPLO°submaW) <br /> CHECK BOX TO EXPEOtTE REQI1€ST 493.00 FEE-RFQUEST PKOCESSED IN 3 eU81NESS DAYS IV <br /> d-1 Q S <br /> DATE <br /> SIGNATURE OF APptJCANT ••.(�''^u — Dwa"rft UAa pyh. <br /> ;Unk <br /> FILE ADORE89 <br /> 4D q 0 fir. C `YYwi n�' E3.b S W . aS¢.r.. t�b s Sana:C4 <br /> W . v a _ <br /> I scan (,� fir ✓ <br /> e 2z o Oa ❑ Unit 5 <br /> COO,o. seas 3 t`T�5 •f - , <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES w <br /> ❑ SOLID WASTE FACILITY <br /> M UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSING ASATEMENT ❑ SOLID WASTE VEHICLE <br /> III OTHER CLEANUP SITE(NON4.OP) ❑ FOOD FACILITY ❑ DAIRY <br /> ■ UNDERORWINO TANK(MOWrORINP>RERtOVALI C3 DOG KENNEL ❑ PKO TREATMENT Pt.ANT <br /> IN HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCKIYARDJCHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ LAND USE APPLICATION SITES <br /> El TATTOWBOOY PIERCM ❑ PODLISPA <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPEC( <br /> 1. List up to ten addressee In the space above. Select the types)of Flea f the tabove mall to thag <br /> the appropriate box(es). At least one Ile type MUST be selected• <br /> 209) <br /> address indicated at)ove. y ntment for review will be confirmed <br /> 2 EHD will notify the applicant if n EHO files exist. An apP� after receipt application. The feet <br /> approximately five business da but no later than ten(10)days ter receipt <br /> should be scheduled <br /> win be Hid for a maximum of five business days for review. Appo <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 rBturned In the same condition as released will m reorganized$900 D staff at the <br /> deposit PK expense <br /> ' <br /> Of the a � <br /> applicant. Future fife reviews by the same app y require <br /> 6. `TENTATIVE appointment dates must be confirmed With EHD staff. <br /> g, Applications received after 3:00 Pm will be processed the next business day. <br /> LDATE <br /> MED APPOINTMENT DATE TIME <br /> FIRPA_DPHONEFAX INITIALS <br /> D YES NO REVIEW DATE <br /> aar+mm <br />