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Y----12/06/04 MON 15:28 FAX 415--48 5480 TETRA, TECH EM INC S,*"- Z0 <br /> - +1 EHD LOG NUMBER <br /> OATS RECEIVED ' <br /> SAN JOAQMN COUNTY !� <br /> -� <br /> ����,, �� � � ���, ExvxsoN�NxA>;H1ra �DEPA>�Tmt>;tvT f <br /> 304FWeberAve3�Floor Stockton.CA9 <br /> {209)468-3420 Fax:(209)46470138 Web:www.co.san joaquirquin ca. <br /> Lus/ehd <br /> DEC 6 2004 <br /> PUBLIC RECORDS RFLFASE APPLICATION <br /> p� <br /> p � ` . <br /> kT�PT ' �RI`'T1E 7�Q/�J✓r?iBUSDIESS(AGENCY: <br /> hU iP <br /> ADDRESS: <br /> PHONE:— FACSIMILE FACSIMILEc ! - . I <br /> TE,NTATW APPOINW ENT DATE: ' — --- <br /> (please allow TO businms drys Gem data of appllcation submIMA j <br /> Q CHECK BOX TO EXPEDRE REQUEST-59 E ROC85 DIN3 BUSINESS DAYS / O <br /> 1 SIGNATURE OF'APPLICANT DATE <br /> . Deparkm tUse Only � <br /> UNIT <br />+ FILE ADDRESS <br /> 53 <br /> W Ma ff ewi zucti C' c,9 3s j3 pt t <br /> W k1 srle RcL <br /> o d,^ c4# 52 Yo `Ip unit 2 /�Q <br /> { �'tfew IT—4—A-71`/ 2 <br /> r 411, <br /> 2 v 36 <br /> s. a f v N1 Unit 3 <br /> N J Yo <br /> 6. suedunR a j <br /> p <br /> Qno <br /> nft 5 <br /> 140 <br /> (� p <br /> ��1S/ n��D�.( JA NC/IR NMENTAL HEALTH DEPARTMENT FILES s <br /> Vj W11 sOLID WASTE FAC <br /> NDEROROUNO TANK(UST)CLFANUP SITE(LOP) D HOUSING ABATEMENT O SOUR WASTE YEHI <br /> I 0 OTHER GLkANUP 9ITE",LOP) - � FOQP FACIIJTY q DAIRY •.� <br /> &51NDERGROUNO TANK(MONITOWNGIREMOYAL) I) DOG KENNEL ❑ PKG TREATMENT PLANT <br /> Er HAZARDOUS WASTE DENERArOR Cl CHICKEN RANCH O pUMPERTRUCKMARDICHEM TOILETS <br /> Q TIERED PERMITTED FACILITY o MOTEUHML 0 LAND USE APPLICATION SITES <br /> tl TATTOOBODY PIERCING O POOUSPA <br /> E3 MEDICAL WASTE FACIUT'r O OTHER(PLEASE SPECIFY) 11 <br /> 1. List up to ten addresses In the space above. Select the type of tiles from the list above¢y checking <br /> the appropriate bex(es). At least one file type MUST be selected. Fax to 209 464A133 or m it to the <br /> address indicated above. ed <br /> 2. EHD will notify the applicant If any EHD Gies ex1sL An appointment for review will bonfihe files <br /> approxlmatelyfirm <br /> ve business days but no later than ten (10)days after receipt of application. <br /> will be hold 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 submitted 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 theapplicant 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. I� <br /> s, Appllcatlons received after 3:00 pm will be processed the next business day. <br /> { 'C2YNFIh"MED;AF}PdtN1`MENTITATE 3� . TIME <br /> 1 TATE CONFIRMkD PHONE FAX INIfIAI S ij <br /> ftPyIEWER YES NO REVIEW DATE. <br /> Mn/Manns / �� (J of �5r �P <br /> 12 l3, (4 WQ(12rl� ad 5 I F <br />