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05/03/2005 13:09 2095227 GEOLOGICAL TECV'-yS PAGE 01/0 <br /> p <br /> D� SAN JOAQUIN COUNTY END LOG PLUMBER <br /> ENVIRoNmNTAL HEALTH DE.PARTwNT 7 g <br /> MAY 0. � 7005 - 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> (209)468-3424 Fax: (209) 464-0138 Web: www.co.san-joaqujn.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERWTISERV!OES PUBLIC RECORDS RELEASE APPLICATION <br /> API'lItlANT e-nL% "34- SUSIIIE iAGENCYs Gtplo : ec cs <br /> ADDRESS: 1rj I <br /> PHONE,• O 3 - ''l 101 FACSIFAILE: a O`1 -_S �;I-^1� <br /> TENTATW APPOINTMENT DATE: w;'XN Tkm. <br /> ' <br /> (Pismo allow 10 bualn"s"from data of application suhmlftl ) <br /> CHECK BOX TO ER„ DITE RE,VEST-103.00 fEE-REQUEST PROCESSED IN S BUBINIMS DAYS l <br /> SIGNATUM OF APPLICANT \A) 0 <br /> uDoparfum t U*Only <br /> FILE ADDREU UNrr <br /> TC4c t ❑ Unit1 <br /> G ra ) <br /> srreel 5 <br /> ,i_l W e1- T r hl "'ift 2 <br /> 4. SVW S-13 W q LA T\ C 0.C <br /> 6 a3�5 Trow luol IN raa Unita If <br /> a sxe, 3`l CK, C c- 4— <br /> r. sera <br /> Unit 4 <br /> d. steel <br /> e ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> II UNDERORDUND TANK JUST)CLEANUP 8171£(LOP) d HOUSING Ai ATEMENT O SOLID WASTE FACILITY. <br /> S OTHER CLEANUP SITE(NON-LOP) ❑ I=Q00 FACILITY 0 901.11)WASE VEHICLE <br /> Le UNDRtpROUND TAMC(MONITORINL#IR MOVAL) C1 0OG KENNEL 0 DAIRY <br /> M HAZARDOUS WASH GENERATOR [a CHICKEN RANCH O PKV TREATMENT PLANT <br /> E3 TIERED P FACILITY 0 lWan,IHO MI. 0 FUNIPER TRUCKIYARDICHEM TOILM <br /> M TATTOOMO�MNO d POOLISPA C7 LAND USE APPLICATION S1M <br /> G MEDICAL WASTE FACILITY 17 gMER WLEASE EPEGIFY] <br /> I. List up to ton addre”"in the space above. Select the type(s)of tiles from the list above by checking <br /> the appropriate hoAes). At least one file type MUST be selected. En to 738 orto-Me <br /> Jltddeess indicated ah9ve. <br /> 2. END will notify the applicant If any EHO files extst. 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 maidmum of five business days for review. Appointments should be scheduled <br /> accordingly. - <br /> 3• A file that Is actively Wing worked on by EK13 staff may not be itrmledlately available for review. A new <br /> application may be Submitted when the file is avallable. <br /> 4. Any file not returned In the same condition as released will be reorganbmd by EHD staff at the expemw <br /> of the applicant. Future file reviews by the same applicant may require a$83.00 deposit prior to review, <br /> a. "TENTATIVE appolnbTwM dates must be confirmed with EHD Staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> i <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> s <br />