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08/28/2002 14:57 2095224- '7 GEOLOGICAL TECHh`,`) PAGE 01/01 <br /> �a-c�-cr�e1 <br /> 01:141'M FR( <br /> TO <br /> V SAN JUAQUIN COUNTYPUpLIC HEALTH SERVICES:el?73 <br /> ENVIRONMENTAL HEALTH <br /> DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR �r / <br /> STOCKTON CA 85202 11 ll`S <br /> (209)466-3420 <br /> PUB IC RECORDS RELEASE APPLICATION AUG 2 9 2002 <br /> APPUCANT- <br /> r) estt BUSINEHE/AGENCYADRESS `1q ` rl \;�. . LT! <br /> PHONE `� t-1�1 ' ` a te S 3 ef RMIT/SERVICEC <br /> FACSIMILE <br /> TENTATIVE'APPO)NTMIiNT DATE AJL, 6 rn > ME�O�l <br /> (Piaase 0 ve 7 to 10 buslnoe <br /> ' fate 4i3fa cationCHECK SOX TO EXPLrDITECWJN <br /> 11:QU T• 7.00 ME_REQ T PRDCEXEBIlUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> V <br /> FiL�ADDRESS THIS RIDE EHD STAFF USE ONLY <br /> \> PROGRAM ELEMENT3 SEARCH <br /> / o 0 <br /> 1 <br /> � v 1 <br /> 3� 3o V) <br /> I <br /> U _ <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-Lbp) Q SOLID WASTE FACItm <br /> q F00p FACILITY ❑ <br /> UNDERGROUND TANK(MONIT RINGIREMOVAL) DOG KENNEL SOLID WASTE VEH1CLf <br /> 0 <br /> HAZARDOUS WASTE GrZNERAtOR ❑ CHICI(EN RANCH ❑a DAIRY <br /> O TIERED PERMITTED FACILITY I 0 M0T6L/HOTEL ❑ PKG TREATMENT PLANT <br /> TATTOO/BODY PEIRCING 0 POOU$PAPUMPER TRUGWYARD/CHEM TOILETS <br /> 0 MEDICAL WASTE FACILITY j ❑ PUsLtC WATER SYS7eNI d IJ LAND USE APPLICATION SITES <br /> OTHER(PLEASE SPECIFY ABOVE) <br /> 1• List up to ten eddrbsses in the space above. Select the types)of files from tho list above by king <br /> chec <br /> the appropriate box(es). At least one file type MUST be selected. ax <br /> address ddres indlgatedbpv�, �--�-4 (2Q9)484,0138 or mall,#�the <br /> 2. EHD will notify the!applicant if any EHD files exist. An app for review will be confirmed <br /> approximata(y fivelbuslness days but no later than ten (10)days after rscelpt of application. The file$ <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is ectivoly being worked on by EHD staff may not be immediately available for review. A new <br /> appllCation may b6.submitted when the file is available. <br /> 4• Any file not return 'd In the same Condition as released will be reorganized by EHD staff at tho expense <br /> of inv applicant. F. Lure file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must b®confirmed with EHp staff. <br /> 6. Applications receini ed after 3:00 pm will be processed the next buslnus Day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX W ITIAL.S <br /> REVIEWED YES ' NQ <br /> �+ no � cele REVIEW DATE <br /> TOTAL P.0] <br />