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01/20/2005 15:01 916-371-2809 RANEY GEOTECHNICAL PAGE -0-1/0 <br /> F-Hb LOG NUMBER <br /> DATE R E CE I VE D <br /> QAQUIN COUNTY 7005 .. <br /> E-NviRoNLmF,NTAL HEALTH]DEPARTMENT t4WNT ViEkLIH <br /> 304*,Rast Weber Avenue,3'Floor, Stockton,CA 95202-2708 ENIV00 <br /> Telephone:(209),468-3420 Fax: (209)464-0138 Web,www,,sjgov.org/chd PERMITI'SE"CES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. <br /> -SS1 Cc is <br /> AGEMCY: J <br /> ADDRESS, <br /> PHONF(11): PHONE(2)-- FA=MILF-:9 16/ <br /> TENTATIVE*APPOINTMENT DATr=,- �fil--<4- <br /> (Please allow 40 business days ftum date of applicafloil3mbM[tial-*70ftfaVV91 only-MUM <br /> CHECK Box-rO EXPEOITE REau 7.$9 ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 SUSINFESS DAYS <br /> SIGNATURE OF APPLICANT DATE _4z--z.Z-z-.,,,Is <br /> UNIT DISTRIaUTIdN 3 untt 1 0 unit. nit 3 WeltM UnItO 0 Othor(iolecgranicAlswinapa) <br /> FILE ADDRESS <br /> SE UNLY <br /> Street# Street Name C <br /> USS HW <br /> U ST 4 <br /> 3:'L 1--- <br /> 6. <br /> 7. <br /> 10. <br /> Speafic Date Range of InfbIrmation Requested:From .J Qq to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> trNnERGI:touti D TANK(UST)CLEANUP Sim(LOP) 0 Housime AsAw;IwENT 0 ftLM WAME FACILrrYMMICLE <br /> OTHER CLEANUP SITE(NON-LOP) M F006 FACIMY WASTE tIRE <br /> 0 <br /> UNDERGROUND TANK(MOP170AINGIREMOVAL) M DO*KRNNeL E-3 PAIRY <br /> HAZARDOUS WAM GENERATOR 0 CHic*vrf RANCH C3 WAsTawATrp TREATMENT PLANT <br /> I <br /> 71 <br /> -REDPFR14111E fACRITY 13 MGTFLNGTEL E3 PumpEKTRui;KjyAm34CurmTv=& <br /> E3 TATT001900y PhdROIN41 0 POOUSPA 13 LANO USE APPMATION&TE3 <br /> r-3 ME010AWASTR FAMMY CI OMER(PLEASE SPECIF <br /> WELL AND SEPM9 PERMFT Mr-0110S ARE AvAjiAiat-r FOR Remw - MoNnAy-FPjbAY$-,00 Am-S.-GOPM - EXCLUMNG HOLIDAYS. <br /> 1. List up to ton addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(ss). At least ona.f lie type MUST be selected. EsxtoL20014-644138 9LMA!_to the add <br /> Indicated pbove.I Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHO.Applications raeaOved after 3,00 Orn will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD fills exist. An appointment for review will be confinmed <br /> approximately ten(10)days after receipt of application. The Ries will bo held for a maximum of five business <br /> days for review. Appointments should be achaduled accordingly. <br /> 1 A flip that I!:% heIna wnrkad on by PHO staff may not be in madiately available for review. A now <br /> application may be submted When the fl!efs available. <br /> 4. Any file not returned in the same condition as released will be morganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EFM4a-d2-M <br />