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05 / 03/ 2005 13 : 09 209522% GEOLOGICAL TECR - 3 PAGE 01 / 0 <br /> SAN JOAQUIN COUNTY EHO Loc NUMBSR <br /> Wrm UL) <br /> ENVIRONMENTAL HEALTH DEPARTMENT 9 <br /> MAY 0 3 7005 304 E Weber Ave 3'd Floor Stockton, CA 95205 7 * z <br /> (209) 468-3420 Fax: (209) 464-0138 Web: Www.co.san joayuin.ca.us/ehd <br /> ENMRONMENT HEALTH <br /> PERMITfSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _. J 4nn Q gdae BUSINESSIAGENCY; � '�01 °� � ey,\ Cc �h , sU 1nt . <br /> ADDRESS: <br /> PHONE; 09 S a. �. - '-1 l ), `l FACSIMILE: :L 0 5 _ <br /> TENTATIVE* APPOINTMENT DATE; _W", \N ci.v .I,,.,J. o � ; Time: T,O <br />' (Flues ■Ilow 70 buelnau tlaye rrom data of application suhmariil) C'a•J i <.w ,Ch S . <br /> CHECK BOX TO EXPEDITE REQUEST 448.00 FEE - REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT o a 1 fE S /Z 0 S <br /> U <br /> DaPefhlllnt 1166 O111V <br /> FILE ADDRESS UNIT <br /> I. s I q -1 qW G c- q .n ' nAr U Cky `rr [3 Unit 1 <br /> 2. Street LA $ S G ra;nfi L na- Tra. r F'„ {i-- A:. <br /> seen Si I U rw W g� Tr C- Fi lk- <br /> 4, Seem �—t $ W Q.-., `-\ f\ ntyr0. C I <br /> e. . Unit <br /> e, swat 340 Fico.-. L; n `(' c- � rr L <br /> 7. Sry Unit 4 <br /> e, aVae <br /> e. I [] Unit 5 <br /> la. sval G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ■ UNDERGROUND TANK JUST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> ■ OTHER CLrANUP STrE juowLOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> r UNDERGROUND TANK (MONITORINGRtEMOVAL) ❑ DOG KENNEL M DAIRY <br /> * HAZARDOUS WASTE GENERATOR M CHICKEN RANCH D PKO TREATMENT PLANT <br /> 0 TIERED 10MM FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PMROINO D POOLISPA 4 LAND USE APPLICATION $ITES <br /> O MEDICAL WASTE FACILITY D OTHER (PLEASE SPECIFY) <br /> 1 . List up to tan addresses in the space above, Select the types) of files from the list above by checking <br /> the appropriate box(se). At least one file type MUST be selected. Fax to (2091494-0139 or mall to the <br /> address Ingicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointment$ should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4r Any file not returned In the same condition as released Will be reorgantrad by EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 6. "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 YES NO REVIEW DATE <br /> WHO <br />