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i <br /> GEOLOGICAL TEGHNT S"t)Loa t4UMsER 4 <br /> 20952242; .k .. <br /> 0510312005 13:09 <br /> 4 _ _ SAN JOAQUIN COUNTY' <br /> Af,TH D YARZ`W1'1T , r <br /> MMMED *1 <br /> ENVMQ'NWNTAL�HE <br /> 304 E Weber Ave 3 i~iQos Stnckt nl CA 95205 <br /> osar+juin.ca.us/ehd <br /> � Ay Q;. 7005 (209)4618-3420 Far- (209)454-4138 Web.www. <br /> Et�iV�R033N � HEA R PUBLIC RECORDS RELEASE AP�'LIC�►TIOI�I <br /> PERNItT�SE ?�110ES Tec <br /> 4nr, y� 8UwkM1AGENCY: <br /> API'�CANT: <br /> D,-3L.- '� 1 FAM)MLE: <br /> PHONE, <br /> TENTATIVE"APPOINTMENT DATE: W,�� �• 4 r. <br /> trv+l►date u€a�M sabmlttlii) (`a�? i e.�-1 ` V-, 5. <br /> (PI.aaF Blow 10 bustlllesa day>F � m <br /> -I-w; <br /> 9 CHECK 9OX To EXPeWE REQUEST-$98.00 TE'E-MQUW PROCESSED INS BUSINESS DAYS) � � ���p S <br /> SIGNATURE OF APPLICANT '�� <br /> oena,tll,ern u"only <br /> UNIT <br /> FILE ADDRESS <br /> 4- rte- p Unit1 <br /> `Trac fist A <br /> olid 2 <br /> Q 9tnn a 3�5 Tc0. IVaL tN rAG 11111{ <br /> e. 3`ia G-ro,, L;n .� <br /> 7. <br /> --- <br /> nit 4 <br /> a. Ow Unit 5 <br /> to epees <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> ■ UNbZROROUND TANK(U"CLEM UP SITE(LOP) 0 It XMNO ABATEMENT CG SOUP WASTE FACILITY <br /> ■ OTHER CLEANUP SITE(NC I-LOP) 0 FOOD FACILITY 0 90110 WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINOIREMOVAL) I.7 DOG KENHI<L ' Ia DAIRY <br /> ■ OAZARDOU9 WASTE GENPRATOR M CHICKEN RANCH O PKri TREATMENT PLANT <br /> o TIERED PERMITTED FACILITY 0 MOTMAIOTEL 0 PUMISER TRUCKIYAROICHEM TOILETS <br /> 0 TATTO016tl Y Pit"He O POOLISPA 4 LAND USE APPLICATION 1j rrEs <br /> t7 MEDICAL 1At1413 m FACILITY OTHER(PLEASE SPECIFY) :. <br /> 1. List up to ten addressee in the space above. Select the types)of flIes from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(309)464-0138 or Mali LaThe <br /> address4ngkaW above. <br /> 3. EMD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approxima"five business days but no later than ten(10)days a#tasr receipt of application. The files <br /> will be held for a maxlmurn of five business days for review. Appointments should be scheduled <br /> aCcurdingly. <br /> 3. A file that is actively being worked on by EHU staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future elle reviews by the same apps cant may require a$93.00 deposit prior to review. <br /> !S. "TENTATIVE appoinurreM dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pro will be processed the next business day. <br /> CONFIRME13 APPOINTMENT DATE TIME <br /> DATIE CONFIRMED _ _ _ . PHONE PAX INITIALS <br /> REVII:WED YES NO REVIEW DA'T'I= <br /> anrJfnv: <br />