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10/ 17 / 2003 15 : 14 9253715915 GEOCON - EAST BAY PAGE 01 / 0 <br /> 10/ 14 / 200309 : 49 46 ( ,18 ENV7RDNMENTP' EALTH PAGE 01 <br /> tnu l,w numovn <br /> N DATE RI <br /> SAN JOAQUINCOUNTY <br /> ENVIRONMENTAL WALL DEPARTMEN 1 <br /> C T 1 "! 20 304 E Weber Ave 3`' Moor Stockton, CA 95205 <br /> 0 <br /> 309) 468-3420 Fax: (209) 454110138 Web : twW,co-san-joaquirLM" ° /ehd <br /> IVVjhL, i N; EiJI HEALTH <br /> ; �sl ? SER ' ;Ir S PYIBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT: .M12 ., t BUSINESSIAGENCY: c'OGO CO A rr9C, <br /> PIZ <br /> PHONE: ( z Z FACSIMILE-. <br /> TENTATIVE` APPOINTMENT DATR: Time; <br /> � Il r laaarf lim to b sines* M from date of Dip Ieatton submittal) 1 <br /> A10 ere a*/y a � > � ( F1 fG� Si ev ace C�1� z �o �9a1 /IeGQ/ fo Ae, <br /> © CHECK BOX TO EXPEDITE Rr6l!l De FEE - CUESTP E 2 BUSINESS DAYS :5(2 �,, <br /> SIGNATURE OF APPLICANT GATE Z2 <br /> Depadmenl 11 Only <br /> iF UNIT <br /> FILE ADDRBea <br /> w 3 p unit 1 1 <br /> L er17t�D [] Unit <br /> s S t z H a r <br /> Unit 3 <br /> s,2 t u fs HInit <br /> r G <br /> Unit 5 <br /> Z ♦ d � <br /> ,a Stant aWLr Cjk. 3 <br /> I ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (U9� CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> AN ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> ❑ OTHER CLEANUP alTP (NDN-LOP) 13 DOG KENNEL ❑ DAIRY . <br /> p UNDERGROUND TANK (MONRORINd1ftEMOVAL) 1;) CHICKEN RANCH C1 PKO TREATMENTPLANT <br /> ❑ HAZARDOUS WASTE ORNERATOR 0 MOTEVHOI [3 PUMPER TRUCKIYARDICHEM TI <br /> t ❑ TIERED PERMITTED FACILITY p pO0L13PA 4 LAND USE APPLICATION SITES <br />` O TATTOOIaODY PIERCING ❑ OTHER (PLEASE SPECIFY) <br />€ ❑ MEDICAL WASTE FACILITY <br /> s of fifes from the list aboya by checking <br /> 1 - List up to ten addresses in the space above. Select the type •i to the <br /> the appropriate box(es). At least one file type MU8T be selected- Fa 2 9 464-0 <br /> address IRdi ted above_ <br /> 2. EHD will notify the applicant If any EHD files exist, An appolntment for review will be confirmed <br /> approximately five business days but no later than tan (10) days after receipt of Applicatlon, The files <br /> will behold for a ntaxlmurn of five business days for review- Appointment* should ba sCh*duled <br /> accordingly, <br /> 3. A fila that is actively being worked on by EHD staff may not be immediately available for ravlow• A nem <br /> application may be submitted when the file is avallable. <br /> q, Any file not returned in the same condition as released will be reorganized by EHD Staff at the expanse <br /> of the applicant. Future file raviews by the same applicant m*y require a $93.00 d*posit prier to revlev <br /> g, TENTATIVE appointment dates must be cpnflrnled With EI staff, <br /> 6. Applications received after 3;00 pm will be proaesded the next business day. <br /> r CONFIRMED APPOINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED JI <br /> REVIEWED YES NO REVIEW DATE <br /> env +e•ozaaa <br /> t <br /> eaauo� <br /> I - <br /> p <br /> i <br /> t. <br />