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RUG-23-2004 15:51 CO' 'nOR EARTH TECH 209 532 0773 P.01i0' <br /> DATE RECEIVED- I EHO LOG NUI R <br /> SAN JOAQUIN COUNTY <br /> ENVC420NMEEIVTAL REALTu DEPARTIImNT <br /> pUG `r 3 2004 304 EWeber Ave 3's Floor Stockton, CA 95205(A? 468-3420 Fax: (209)464-0138 Web: www.co,sanjoaqub Lcaus/ehd lqbw7 <br /> SE VIEECES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLIGWT: �}�7 'y FEZ suslNEswAGERcY: C.r31U'DoR F�1 TN-" -"HII�oCL �' <br /> ADDRESS: <br /> PNON[ e� FACSIMILE.- -- - <br /> TENTATiVE'APPo1NrMENTDA'rE: � �: o200T nma: STS <br /> (Please allow 10 buulr days from date of application submittal) <br /> CHECK Box TO EXPEDITE RE EST-S93.00 --REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE .04 00 <br /> O0=lrne4 Use Only <br /> FILE ADDRESS UNIT <br /> �. aux, $ `• b O O AJ f 15 t � <br /> ✓ z jUnft 1 <br /> ✓ a. so-ex 00 L RRh7 5 Unk2 <br /> Unit 3 <br /> s, sv.el c IT <br /> ✓ 7. s S U51 Unit4 <br /> sum L cm 5 , <br /> F <br /> D ❑ Unit 5 <br /> +a, &Aa'. D <br /> ENVIRONMENTAL HEALTH •e a <br /> UNDERGROUND TANK(UST)CLEANUP SITE(L0P) Q HOUSING ABATEMENT (Pr SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) U FOOD FACILITY Or SOLID WASTE VEHICLE <br /> QS, UNDERGROUND TANK(MONITORNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FAcurY 0 MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> Q YATTOO/BODY PIERCING D POOLISPA pC LAND USE APPLICATION SITES <br /> MEDICAL,WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the But abc ye by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 454-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. 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 FHD staff may not be Immediately available for review. A ne <br /> application may be Submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganbed by EHD staff at the experts <br /> of the applicant• Future file reviews by the same applicant may require a$93.00 deposit prior 11018vie' <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED ­ VI <br /> YES NO REVIEW DATE TOTAL P.O: <br /> +3-�G .9 55"1 E I Dorado U s t Fele Ovd b P F.. <br />