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06/03/2005 12:23 209527 <br /> GEOLOGICAL TECOCS PAGE 01/0 <br /> EHD LOO NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> Elvv <br /> f r 11 >:ROxiyi>;NTAI,HEALTH DEPARTMENT I `7 q 43 <br /> R E,&O�� C'U 304 E Weber Ave 3n'Floor Stockton, CA 95205 u�ehd <br /> ll u (209) 468-3420 Fax: (209)464-0138 Web:www.co.san Jot1u <br /> ow"N 0 3 7005 PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIP c of <br /> n 9i` ., W sees eUSINESSIAGENOY: <br /> ADDRESS: s <br /> PHONE:,, r dna, _ FACSIMILE: <br /> ._ . <br /> WI II I.'�r� Dn GV2S � ��• <br /> TENTAT1VEe APPOINt' iF mT DATE: <br /> Mlywrj? <br /> Te7 _ apPiloetlon submMil13 CHECK SOX TO EXPEOrM REW EST• -N�eOUgE PR <br /> .cEsSE IN H BUSINESS DAYS <br /> 9 rn r. V V DATE W <br /> SIGNATURE OF APPLICANT \\j Deearhnera use only <br /> UNITFILE ADDRESS <br /> ri. & Aire V f " R�= fi�Uni[1 <br /> �. ansa 170 <br /> Z a� f17� 'Q ❑ <br /> sum p <br /> sum � <br /> Onft 2 <br /> 4. nip nit 3 <br /> a seeei <br /> e. nasi V-") <br /> i " Untit,4 <br /> r aeea <br /> e eves Z^ (e li g�ln"it 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK NST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT L7 SOLID WASTE FACILITY <br /> f� OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY Ci SOLID WASTE yEFIICLE <br /> t9 UNDEROROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL ❑ DAIRY <br /> CHICKEN RANCH D PKO TREATMENT PLANT <br /> V ❑ CHMP <br /> HAZARDOUS WASTE GENERATOR q M KEEN AN O PUMPER TRUCKNARDICHEM TOILETS <br /> 6 TIERED PERMITTED FACILITY TEL <br /> ❑ POOUSPA CI LAND USE APPLICATION SITES <br /> ❑ TATTOO@WDY PIERCING CJ OTHER(PLEASE SPE <br /> O MEDICAL WASTE FACILITY <br /> 1. List up to ten 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. &to(2091464-0138 orpl�11 to the <br /> AddresSindicated above. <br /> 2. EHD will nottfy the applicant if any EHD files exist An appointment for reviow will be confirmed <br /> approximately five business days but no later than tan(10)days after receipt of appticoUOn. The files <br /> V411 be held for a maximum of five business days for review. Appoitment$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 1116 tS available. <br /> 4. Any file <br /> applicant. Future returned In file reviews by the samee same condition as )applicant ed will <br /> may requireea 5900 deposEHD it prior to at the review. <br /> of the app <br /> rmed with EHD staff. <br /> 8, *TENTATIVE <br /> pliccations appointment <br /> after 3:00 pmst be Wil beprocessed the ext business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> Ramey =D YES NO REVIEW DATE <br /> VW4 <br /> n 53 <br />