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FROM Geo--Pl+ase Envirarnnei;tai lrtc. FAX NO. 209565 95 -..fun. W09 2006 03:23RI P2 <br /> EHD LOG NUMBER <br /> PATE RI=CEIV50 SAN JUAQUM COUN ff <br /> D E C D 1J LSD E om"NTAL HEALTH PARTMEPIT` <br /> 304 F_ Weber Ave 3:d Floor Stockton,CA 95205 <br /> JUN 9 E�0K209)468-3420 Fix; (209)464-0138 VVeb.Www.c .san joaquin.ca..us/ehd <br /> bct4 <br /> ENVIRONt EI'q T HEALTH pUBLIC RECORDS RELEASE PLICATION <br /> P }fin <br /> APPLICANT: SUSINESSfAGENCY: <br /> Z // � <br /> . - -3� ? <br /> ADDRESS: t...• <br /> PHONE: ► FACSIMILE: 4' <br /> I <br /> Time' <br /> TENTATIVAPpOlHTMENT DATE: <br /> E* <br /> (FIq"a allover 10 bUOIMas days from date of a pplicstion submittal) <br /> CHECK 60X TO FXPEPVM REQUEST-$93.00 FU-REQUEST PROCESSED N 3'S iNESS pAY,S , <br /> l3A <br /> •I'E ... -- <br /> SIGNATURE OF APPLICANT rtment Use only <br /> UNIT <br /> FILE AOfl�S <br /> ❑ Unit 1 <br /> x, n <br /> Unit 2 1 <br /> y 'r <br /> 400, <br /> 5. 5lraei linit 3 j <br /> .l?�t3it <br /> 7. StreetMena <br /> 9. Street <br /> ,o. s>net i <br /> Ef4VIRONMENTAL HEALTH DEP TMENT FILES f <br /> D HaUSItEC�ADATEME r 0 SOUR WASTE FACILITY <br /> d'UNDERGROUND TANK(UST)CLEANUP STTE(LOP) C3 FOOD Nr-T-AASAI 0 soLiD WASTE VEHICLE <br /> a-0T71EitCLE{�NLIPSITE(NON•LOP) E3 DOG KENNEL. Q DAIRY <br /> UNCERGROUND TANK(MOWORtNOIREMOVAL) C3 CHICKEN RANCH A pKe TREATMENT PLANT <br /> * HAZARDOUS WASTE GENERATOR Cl tAoTEL1HOTEL 0 PUMPERTRUOWYARD1CHEM TOILETS <br /> * Timm pERMTrMD FACIL" o POOLfSPA D LAND USE APPL.ICAT(ON SMES <br /> ❑ TATTOO15ODY PIERCING D OTHER(PLEASE SPEC] I <br /> C] MEDICAL,WASTE FACiLM ' <br /> 4 List up to ten addresses In the space alcove. Select the typ*)of files from the list above by checking <br /> the appropriate l9ox(es)_ At least one file type MUST b selected. ax o 209 454-Q138 or maii_fio#?� i <br /> address indicated abo e. appointment for review will be confirmed <br /> 2, F_i4D aR wnotify the applicant if any EHD files exist. Art pp after reGei t of application. The files <br /> apprux'iMately five business days but no later than ten(lo)days P PIs <br /> will be held for a maXimum of f�►e business days for review, appointments should ani scheduled <br /> accoldingly. <br /> 3. Afile that is actively beingworked an by EHD staff Ina not be immediately available for review. A new <br /> appl[cation may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as release will be reorganized by EHD posit at the expense <br /> 3.00 deposit prior to reviOW. <br /> of the appftant. Future file reviews by the SaMe apgll nt may reciuire a$9 <br /> E. *TENTATIVE appointment dates must be confirmed wi h EHD staff. , <br /> 6. Applications received after 3:00 pm will be processed a next business.clay. <br /> CONI=LRM Poii�VENT DA79 �4ME :. <br /> DATE GQiVF1Rl>li D RI QI�fEE FAX.. iNI"I'IAL, <br /> REVIEWF13 NO R VIi=W DATE <br /> tt0se U40 <br /> zuar�ova <br />