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May. 18. 2006 9:52PM Advanced GeoEnvironmental No. 4936 P 1 � <br /> k, F_HD LOG NWA R <br /> DATE=RECEIVEDI <br /> - z. �j :- SAN JOAQUIN COIWY <br /> IR REM E l U E D. ENVIRONMENTAL REALTH DEPARTMENT <br /> 304 East Weber Avenue,Yd Floor, Stockton, CA 95202-2708 *1 3007 Iq <br /> MAY 1 LOf�6. Telephone,: (209)468-3420Fax, (209).464-0138 Web:www.sjgov.org/ehd <br /> ENVff�ONf cNT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> P r~ n <br /> SUSINSSIAGENCY:AF6^ <br /> ADDRESS: (2311 S Q y f <br /> PHONE(i): . a PHONI;(z): dD - FACSIMILE: Lo?- x 1 1 1 <br /> TENTATIVE*APPOINTMENT DATE: DCS Tlms: :DO t*k <br /> (Pleaao allow 70 business days from date of 1ppI128ft,submittal-"Tentatfve only-must be confirmed) <br /> CHECK BOX TO EXPEDITEE T-$93.00 FEE(CA CH QCK ONLY)•REQUEST PROC€43ED tN 3 BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNiT DtSTFtIBUTION 0 Unit i Unit 2 O Unit 3 0 Unita 0 Unit S Q Unit 8 A Other(electronlclllstsimaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Stet# Street Name city <br /> 2. <br /> 3, l 1s a tt . <br /> a. uS �G <br /> 5. <br /> u iIF_' KOOO <br /> � F <br /> 6. -f <br /> 7470-0 kl6od III <br /> s. <br /> 10. <br /> Ir Specific Date Range of.lnformatian Requested:From � --w- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f1-iAZARDOUS <br /> NDMOROUNOTANK(UST)CLEANUP SITE(LOP) C2HOUSINGA 3ATEMENT 0 SOUP WASTE FAM YNIKICLE <br /> THERCLEANUPSIT'E(NON-LOP) 1:3FooaFACILITY CI WitsTETIRE <br /> NDERGROUNDTANK(MoNITORINGIRwovAL) In DOG KENNEL 0 DAIRY <br /> WASTE GENERATORCHICKEN RANCH 0WAFTEWATEFCTREATMENT PLANT <br /> 0 nERED PERM1 TED FACILITY 0 MOTEUROTEL 0 PUGfPER YRUCEJYAR�CtIEM TOILETS <br /> I ❑TATTOOIBOIDY PIERUM 0 PGOUSPA ALA140 USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT kLIORDS ARE AYAILA@LE FOR Review- MONDAY-FRIDAY 8.417 Ain-5:00Pm - EXCLvoima HOLIDAY$. <br /> 1. Lfat up to ten addresses in the apace above. Select the type(s)of flies from the list above by chocking the <br /> i approprlate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address <br /> Indleated above. Address ranges will not be accepted-for additional ass[s nc®with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD fifes exist.-An appointment for review will be confirmed <br /> approkimataly ten(10)days after receipt of application. The files will be held fvr a maximum of five 1:=Qsava <br /> days for review. Appointments should be scheduled accordingly. , <br /> 3. A file that is actively being worked on by EHO 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 EMD staff at the expense 4f the <br /> applicant. Future file reviews by the same applicant may require a$93,00 deposit prior to reAew. <br /> END 41I42.00 <br /> fnaros . <br />