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x/04/2005 11:20 FAX 209 94'80" 191002/002 ' <br /> DATE RECEIVED <br /> � , �� "" "'�". ��• ) <br /> n�� SAYJOAQULI� COUNTY <br /> E-NMONMENTA.L.Ef EAj Tu DEPARTMENT <br /> APR - ,� 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> - 0�09) 468-3420 Faz; (209) 464-0138 Web: www.co.san-joaquia.ca.uslehd <br /> E#ViR yflPSET ICES PUBLIC RECORDS RELEASE APPLICATION <br /> PL�PJSlTfSE�V1C�S <br /> APPL.ICAlTT: zyxh 7ia5i Vs BUSINESSIAGEHCY: �LE.i G V % <br /> AaDfzESS' <br /> PHONE: C1yg -134r, FACtS�IMILE: �! �'In <br /> TENT'ATM1 APPOINTMENT DATE: _!l Time: �a��c74 <br /> {Please allow 10 6usimms days from date of application submittan <br /> CHECK BOX TO EXPEDITI;REQUEST-$93.0 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS y <br /> SIGNATURE OF APPLICANT DATE J <br /> DeoertmentUse Only <br /> FILE ADDRESS UNIT � y <br /> -�q-$ -� <br /> aA., LA p Unit I <br /> 2. /J. '1ZIP3.0 - <br /> sacs G Unit 2 <br /> 4. Sand <br /> s. s Unit 3 <br /> a. Sure( oty <br /> Unit 4 <br /> r_ s� [3 Unit 5 <br /> I' �o. srea <br /> i <br /> ENVIRONMENTAL 14EAL.TH DEPARTMENT FIDS !f <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING•ABATEMENT ELso ID WASTE FACILCi'Y ' <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> IIS UNDERGROUND TANK(MONIrOR1NGIREMOVAL) 0 DOG KENNEL M DAIRY i <br /> A HAZARDOUS WASTE GEKERAXOR Cl CHICKEN RANCH 113PKG TREATmENT PLANT 1 <br /> ❑ TIIrRED PERMITTED FACILITY 0 MOTELJNOTEL 0 PUMPER TRUCK1YARDICHEM TO i <br /> 0 TATTOOBOD`(PIERCING E3POOLJSPA IS LAND USE APPLICA-no til SITES <br /> CI MEDICAL WASTE FACILfrY 0 OTHER(PLEASE 5P7~C Y <br /> !. List up to ten addresses in the space above. Select the types)of files from the list above 6y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46.4-0138 or mail to the <br /> address indicated above. <br /> 2_ EHD will notify the applicant if any EMD files exist An appointment for review will be confirmed <br /> approximately five Guslnes:s 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_ 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 nev <br /> application may he 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 the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to revier _ <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 /> .014FIRMED..%�,P.0jNTMEN1;t-ATE' _zP '. T'.,0�.... TIME u �1r ="- <br /> :pAT GONIRMi=Ci ° i: HONE= FAX'' <br /> REVIEWED YES NO REVIEW DATE: ' <br /> • eeso�aaa-0oe - <br />