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06/03/2005 12:23 209527 GEOLOGICAL TECWS PAGE 01/0 <br /> EHD LOO NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> p LVED E 3041E Weber <br /> Ave L HEArStoo pEPAR�NT 17 43 <br /> �OO� 304 B Weber Ave and Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.o04810oatluin.ca.us/ehd <br /> ;l N ® 3 7005 PUBLIC RECORDS RELEASE APPLICATION . <br /> ADDRESS:_ I\O\ -14" <br /> PHONE:, ��-0 �'a'-tit\1� _.__. FACSiMLO i aC/A� 5a') " LA2Q <br /> W i It Deq_0T'%C1 Ot\ "\12 b <br /> TENTATIVE"APPOfNTMpNT DATE: Tlaw <br /> iPfeeae/.7Nkm 10 bwTn6ce m of aPPOCsdOn submwo <br /> CHECK BOX TO EXPEDITE IIJ EST•;93.MF?-FtEQ�UgES P R ED IN 8 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� Vel AL c� DATE <br /> Donartmeru UOe ONY <br /> FILE ADDRESS UNIT <br /> 1. a. U11NIA ASR-.m X65,3;,: Unit 1 <br /> a men M L. Q O A��aft 2 <br /> a sreel <br /> Z <br /> A? )nit 3 <br /> Wt <br /> 1 e" 1 �° Unit 4 <br /> a saam <br /> e. s� <br /> o. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> pfVI <br /> UNDERGROUND TANK(UST)CLEANUP SITE(IAP) 0 HOUSING ABATEMENT LA SOLID WASTE FACILITY <br /> Jg OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> % UNDERGROUND TANK(MONITORINGmEMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> '9�HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> • TIERED PERMITTED FACILITY ❑ MOT"OTEL ❑ PUMPER TRUCIUYARD/QHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY),_,,,_ --- <br /> 1. List up to ten addresses in the apace 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. Fpx to(2001464-0138 Or MON 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 live business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointmenfa 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 availablo. <br /> 4. Any fie 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 confined with EHD staff. <br /> B. Applications roceived after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RiEviSVED YES NO REVIEW DATE <br /> M04"240 <br /> aiarmm <br />