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Jun. 13. 2005 8:34PM P'nced GeoEnvironmental No, 0970 P. 1 <br /> SAN JOAQUW COUNTY EHD LOG <br /> NUMSER <br /> E'WMON1VMAL HEALTH DFPARTMMNT <br /> . iJid 2O0 304 8 Weber Avo aro Floor Stockton,CA,95205 <br /> 209)468-3420 Fax: (209)464-0138 Web:www.co.=-joaquin.c&us/ehd <br /> ENVIRONMENT HEALTH I 9-0w7? <br /> P P C RECORDS RELEASE APP11CATION <br /> APPLICANT: USNE&SAAGFMCY: QOrLIQACej 6;9 r• <br /> PHONE, /`Ind��FACSBMtr AW T ` f YA, <br /> TENTATPiV APPOINTMENT DATE: AjaTime: <br /> (PIM0 anow 10 bu**m df.Mire date Of APPFAWon subWA&Q <br /> CHECK BOX TO UPEDITE REQ - 03.00 FEE- b W S BUSINESS BAYS <br /> SIGNATURE OF;APPLICANT DATE /4A"A/�� <br /> Da*%ant use only <br /> t UNIT <br /> 0 Unit 1 n� <br /> d Unit 2 V <br /> a am Unk 3 <br /> 71 Sim <br /> & CIV Aar <br /> a ❑ Und 5 <br /> tog ak <br /> AUMENTAL HEALTH ARTN0.NT FILES —_ <br /> TANK(ANT)ra.EANUP SITE(LOP) d HM N G A9AIR ENT ❑ SOLip WASTE FAMMY <br /> OTM QM"SITE"U" ❑ FOCQ FiC Y ❑ SOLS WASTE VEHICLE <br /> tsplfDMlKKM TMMC fAMITOIGHMENIMA4 13 We 1034MM d DAIRY <br /> HAZARDOUS WAs1'E<i UNWATOR d CHICKEN RANW D PKti TR811TM1W PLANT <br /> 17119tED PIRM"WO FACILITY ❑ MOTIB'lIH EL ❑ PUMPER TMJCWARUK* Y TOILETS <br /> a TATTOOMODY PMO ❑ PODUSPA ❑ LAND USE APPLICATION Sites <br /> ❑ UEDICAL WASTE FACLITY ❑ OTHER M.EASE SPECIFIC) <br /> 1. List up be ten addresses In the space above. Select the type(s)of tiles from the M above by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Eax to(209)4MM38 or map to the <br /> rose Indicated above. <br /> Z EHD Wlli notlfy the applicant H any END files east. An appointment for review will be confirmod <br /> approxitraitely five business days but no kaiser than tan(10)days after rex elpt of appikaton. The files <br /> will be held for a maximum of fire 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 the applicant. Future file reviews by the same applicant may require a$93.00 doposit prior to review. <br /> 6. "TENTATIVE appola tnent dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business clay, <br /> C NAM, D <br /> Q A >N7MeNT DAT$: <br /> DATE CONFIRIYIED P N): FAX. INITIALS <br /> ., <br /> MB YES NO REVIEW"DATE <br /> W&MM <br />