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10/14/2002 15:57 2095224227 GEOLOGICAL TECHNICS PAGE 01/01 <br /> 01-23-2001 01:14PM FROr • TO 5385852 P.01 <br /> SAN J67(QUIN COUNTYPUBLIC HEALTH SE ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 <br /> I (208)468-$420 <br /> PUBLIC RECORDS RELEASE APPLICATION 14341 <br /> APPLICANT n J W �Sk_ a &_�_1 BUSINESS/AGENCY <br /> ADDRESS `\) (4 <br /> PHONE FACSIMILE a.o 01 -- 5 a <br /> TENTATIVE'APPOINTMENT DATE w��_ z F o.'.�l TIME <br /> (PlaaSe QN0 7 to 10 business days from da f applies submittal) <br /> T ENVIRONN',t <br /> l ,, s <br /> CHECK BOX TO EXPEDITE REQUEST.$87.00 QUEST PROCE89E 3 B SiNH68 DAYS PERM�T�SE. \'1C�S <br /> SIGNATURE OF APPLICANTNL,-,A, \ ' DATE <br /> I <br /> FILE ADDRESS THIN SIDE EHD STAFF U8H ONLY <br /> I PROGRAM ELEMENTS SEARCH <br /> c\-•tea L�o�. <br /> T--' La d� <br /> i <br /> I <br /> , <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IIB UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINQ ABATEMENT ❑ SOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY C1 SOLID WASTE VEHIC" <br /> 10 UNDERGROUND TANK(MONITORINO/r EMOVAL) Q DOG KENNEL d DAIRY <br /> • HAZARDOUS WASTE GENERA}tOR n CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FAC1Lt Y I D MOTELIHOTEL M PUMPER TRUCK/YARD/CHEM TOILETS <br /> Ll TATTOO/BODY PEIRCING ❑ POOUSPA 11 LAND UBE APPLICATION 81 reS <br /> ❑ MEDICAL WAST>r FACILITY ❑ PUBLIC WATER SYSTEM d OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addr6ges In the space above. Select tho type(s)of files from the list above by checking. <br /> the a s)propriate bo' (�c es . At least one file type MUST be selected_ Fax to(209)484-0j:3S pr mij,jJ,p thr <br /> address Indicated boyo. <br /> 2. EHD will notify thethe!applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately PVC14L siness days but no later than tan(10)days after receipt of appllcatlon. The files <br /> will be held for a maximum of five 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 a"lloble for review. A new <br /> Application may IJ4 submitted when the file is available. <br /> 4. Any fife not returned in the same condition as released will W reorganized by EHD staff at the expense <br /> of the applicant F tore File reviews by the game applicant may require x$07,00 deposit prior to review. <br /> 5, "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> [Cd�aNFIRMED APpoiNTME i NT DATE MIME <br /> [TATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YE5 NO REVIEW DATE <br /> Ql oa U o <br /> TOTAL P.01 <br /> ' r. <br />