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Au€;. ;/1, 2005 3.05'Y Advaiced GeoEnvironmental 1 <br /> DATE RECEIVEC EI-ID I.vu NUra16EF� <br /> SAN JOAQUIN COUNTY <br /> r e �j FWf.RONMElNTAL HEALTH DEFARTMEIIT <br /> 304.EastWeber Avenue, 3r6 Floor, Stockton, CA,95202-2708 <br /> l <br /> AUG :3 <br /> Tek-phorle: (209)468-3420 Fax:(209)464-0138 Web:www. jgov;.org/eh.J <br /> ] 2006 <br /> ENVIR 1.FNT 14F <br /> =A111.1FIT13LIC RECORDS RELEASE APPLJCATJON <br /> -- <br /> A PLi�k(n4�k ( Un 11,0— 60 <br /> a SI-0 BUSINESS/A<',EN�I�'+l IAU(4f1 1�I r_ <br /> �4T)DRESFt: 12_ ^a a�� 01`777 s— <br /> /ZI/o4 PeiONf'.('I) .�`fV10 ��.00 _PHONE(x) Z_1��� a FAC$'MILE: <br /> U,f(ed Qr✓' i d- TENTATIVE`APPOINIMEN'r DATE: —Time: <br /> k-_rt hVr 1WC;oLj (Please allow 10 business days from date of application submittal-*Tents ve only-must be confiimad) <br /> shv,� 95•C�, gy.c. <br /> CHECK EQX TO EXPEDrrREfdW--.ST-3 E(C S OR CHFCK ONLY)-REQUEST PROCESSED igN�Z 13 <br /> 13J8INESS DAYS <br /> :SGGWATURJ:OF 11PPLICANT -, 1'!� -----[SATE <br /> UkVIT DISTRIBUTION]] 0 Unit:i Unit 2 Vnit r1ifift4 ot Units l`nit 8 d OCiler(of ectC011Ic11 /rndp&j�� <br /> FILE ADDRESS EHO USE ONLY <br /> _l�tt>tiet! Street Name City _ { <br /> Pod <br /> 2. <br /> 7. <br /> 'T <br /> Specific Date Range of Infommation Roquastect:Frpm _. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE'S <br /> II,UNDrRGROUND TANK(UST)Ctz.ANUP SITE(LOP) 0 Housiw ABATEMENT 0 S(Y iV WAZTE FA71Lf�YII�EHICLE <br /> �CI,OTH=R•CLEANUP S PTE(NON-1-015) InFOOD FACILITY O WA"TE T IRr <br /> I.IIND_RGROUND TANK(MONITORINGAILfl1GVAL} 0 DOG KENNEL O DAIRY <br /> I.HA:LI,RUOu$YYA:,T-�(,EN=RATC0 0 CHICKEN RANCH ❑WA11TI EWATER�REATN04T PLANT <br /> I--'TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PIJVPEK THUCMJYARDICHEM TOILETS <br /> M T.ATS00 BODY Pls1 clw C POOLISPA �f�LAND USE rAPPLICRTICIN SITE: <br /> Cl MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> _ WELL ANO SEPTIC PERMIT FIEGciiDS ARE AVAILABI.E FOR REVIEW- MONDAY-FRIDAY 8:C4 Am-5-.00P64 - E%cu UDING HOLIDAYS. <br /> I. Liist rap to teen addressers in the spike above. Select the type(s)of files from the list ab,Jve by checking thr, <br /> appropriate box(es). At least one file type MUST be selected, FaK to 201464-0138 or rrrail to the addre <br /> indicated ab>r vl e. Address ranger:will not be accepted—for additional ausistance with file a6dresses,contact. <br /> the EHD.Applications;received 0ter 3:00 pni will be processed the next:business day. <br /> 2. The EHG will notify the,applicant If any EHD files exist. An appointment.far reviewwilt ba confirmed <br /> approximatsiy ten(10) days after recelpt of application. The files will be held for a maximum of five husinets <br /> days for taview. Appointmonts chould be sti.heduled accordingly. <br /> 3. A 4•ile thaI IE,a-.tivaly being workmi on by EHD staff may not be Immedlatoly mailable for review. A nmv <br /> application may be sLlbmltt)d whon the file Is available. <br /> 4. ,Any file not retumed In the srilme condition Ws released will be reorganlzcd 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 reviewr <br /> Fri <br /> 1 YW <br /> I i <br /> — <br /> 1114ras <br />