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06/03/2005 12:23 209527 GEOLOGICAL TECS PAGE 01/1) <br /> EHD LOO NUMBER <br /> DATE RECEIVeD SAN JOAQUIN COUNTY <br /> �� �� �� <br /> ENVIRONMENTALWeberAve3 HEALTH DEPARTMENT <br /> �EEV 304 T3 Weber ve aro Floor Stockton, CA 95205 <br /> l u (209)468-3420 Fax: (209)464-0138 Web: www.posan joaquin.ca.us/ehd <br /> J1 J 0 3 7005 PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> LNVrl7 I 'L - VV a BUSINESSIAGENCY: 01 <br /> P f! F <br /> ADDRESS: { S <br /> PHONE: <br /> Boa baa- \1�1 FACSIMILE: <br /> •_�� <br /> 0.)111 I '�Y� DCS G=t�RS <br /> TENTATIVE"APPOINTMENT DATE: -^^Thne! <br /> (Ple�e{/�(l/o�w 1a buat*RFQUE <br /> El CHECK apX TO EXPEDITE ftEAf93. F'- H BV91NE$S DAYSSIGNATURE OF APPLICANT j9 M r DATE <br /> l\.Jl Daoachnent use OnIY <br /> FILE ADDRESS UNIT <br /> I. sneer <br /> Unit <br /> lu�. abael - n, <br /> - � jinn z <br /> a Stt) .e-*nit 3 <br /> 7 i y00— Unit AI <br /> e. saes <br /> io. cern <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1d UNDERGROUND TANK(VST)CLEANUP SITE(LOP) 10 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER GLF_ANUP SITE(NON-LOP) ❑ FOOD FACILITY d SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 7-HA7..AROOUS WASTE GENERATOR 12 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY M MOTUMOTEL ❑ PUMPER TRUCKNARDlCHEM TOILETS <br /> ❑ TATTOprBOOY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list abovo by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(249)4640138 or mail to the <br /> address indicated above- <br /> 2. EHD will nottfy the applicant H any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after recoipt of application. 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 available for review. A new <br /> application may be sultmktod 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 /> 5. '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 RIEVIEW DATE <br /> PHP� <br /> IIIIIROW <br />