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06/03/2005 12:23 2095224^"7 GEOLOGICAL TETCHN""•S <br /> PAGE 0110 <br /> EHD LOG'NUMBER <br /> DATE RECEIV813 SAN JOAQIIN COUMY <br /> f` E ONMENTAL RE.AL'H DEPARTMENT' <br /> �EC X417 DD 304 E Weber Ave 3-4 Floor Stockton, CA 95205 <br /> (209) 46&-3420 Pao: (2.D9)464-0138 Web:www.co.sffln j0aquin.ca.usl6hd <br /> pUBL.IC RECORDS RELTASE APPLICATION <br /> U91NE68IAGEINCYt °t <br /> Pff" s <br /> AnPRESS: <br /> PHONE: <br /> - 1 FACSIMILE: 5 <br /> �►,}r II �('�� acs �=tVtS • <br /> TENTATIVE"APPOINTWENT DATE: �� <br /> (PIwwo10W 10 in*a6 ■PPS submltfAl) <br /> 7 . lr <br /> cHem wx TO ExpEa1TE I= i � REQUEST M a BUSINESS DAYS <br /> \�J <br /> SIGNATURE OF APPLICANT "�R1 <br /> DATE S <br /> Dsvat'finerri uae only <br /> FILE ADDRESS `Nff 7r' <br /> Unki <br /> 2 8 iA L- <br /> a sa" 2 <br /> 4- <br /> a s� 5%voe 3 <br /> - <br /> r <br /> lam- <br /> Unit <br /> v2jctos N) . <br /> a. a� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FlLE�i <br /> 0. UNDERGROUND TANK(U"CLEANUP SITE(IAP) 0 IIOU$INa ABATEMENT 0 SWO WASTE FAC10Y <br /> pI OTHER aLEAKUP 611E(NONAOW) 0 FOOD FACILITY Ca $014D WAgte VMCLE <br /> 19 UNDERGROUND TANK(90WTQRiIN3rZMVAL) C1 Doe KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GEMERATOR In (MCKEIN RANCH C] QKO TREATMENT PLANT <br /> TIERED PERMITTED FACILCtY 0 NIOTEUHOTEL C] PUMPER MU0WARDQHEM,T01LE1.8 <br /> M TATTOOBOOY PIERCING ❑ POOLISPA ' 0 LAkD List APPLICATION SITES <br /> O MEDICAL WASTE FACILITY M OTHOR(MEASE SPE <br /> 1. List up to ter►addresses in the space above. Seisct the type(s)of files from the list above by checking <br /> the appropriate boxtes). At least one fife type MUST be selected. EM to=45447 it to the <br /> addrass indleatsd <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> alpproidmately five business days but no Miser than ten(14)days after receipt Of applicaon. 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 r evlew. A new <br /> application n"be submt ted when the file is available. <br /> 4. Any file not re fumed In the same condition as released will be reorganized by EHD staff at the expame <br /> of the applicant" f=uture file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Application racelved attar 3:00 pm will be processed the next business day. <br /> CONFIRMW APPOrNTMENT DATE TIME <br /> DATE CONFIftMED PHONE FAX INITIALS <br /> Ri. eVIF.Eb yes NO RPEVIEW DATE <br /> . sianoas i <br /> I <br />