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.a <br /> 05/03/2005 13:09 209522 GEOLOGICAL TECH' -'S PAGE 01/0 <br /> SAN JOAQUIN COUNTY o Loc NUMBER <br /> F-NYIItONMENTAL HEALTH DEPA1N naw g <br /> MAY 0-17005 304 E Weber Ave 3'' 1 rr <br /> *z <br /> Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464_0138 Web:www-co.san-joaquin.ca.us/chd <br /> f ENVISONMENT HEALTH <br /> PEROTISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> API oc"T: <br /> n4 <br /> t,c.s4. r <br /> 114J81NE$SIAGEMCY: ;010 : e c v <br /> f ADDREGS: <br /> PHONe. A� FACSIMILE:,::LO°l - S :L^�� � ...�^. <br /> TI=NTATI)W ApPOINTMeMT DATE• W;-\N d o r,$�1P s W o"`�a• �'•��e <br /> (P1e+se•Draw 10 bos"its <br /> Bays fTvm dots of appgcptlon saNmlttall t''o..'1 i•e..w <br /> CHECK Box TO EXPEDITE REQUEST.$03.00' -REQUEST PIt0CEg8f D IM 3 BMNLSS DAYS i <br /> SIGNATURE OF APPLICANT � ��� I rE �/Z' 0 S <br /> uTDepub"M use Only <br /> FILE ADORESS UNIT <br /> q W. G rq,n a TT - e n p Unit 1 <br /> ]. 9uee1 S 5 G ow 'Trac. tt <br /> swao C7 can W , Tr N .,r11t 2 <br /> 4. &4W W . PQ rM,.. I-A 4N C 0.C. <br /> 6. 9"m 3-1$ 'tCq LY GL (N) CRY Tr�a Unit <br /> e. Suva. . Gra, <br /> r. svo1 <br /> Unit 4 <br /> a ease$ <br /> eM Unit 5 <br /> asaw <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ■ UNDERGROUND TANK(UST]CLEANUP 8l7E(LOP) 0 HOUSIKO ABATEMENT 13 SOUR WASTE FACILITY <br /> ■ OTHER CLEANUP WM(MoN-LOP) 0 POt]O FACILITY o SOLID WASTE VPHICLE <br /> ■ UNDMiOROUND TANK(MONITORIN(UREMOVAL) O 000 KENNEL 0 DAIRY <br /> 0 MCAROOU9 WASTE CENP"TOR 4 CHICKEN RANCH Da P"TMATMEFtT PLANT <br /> 0 TIERED PERNITTIF0 FACILITY U WKrW-LMOTEL E3 KIMPER TRUCKIYARDIGW A TOiLET6 <br /> M TATTOO/BOD PWJMW(3 13 POOLISPA C3 LAND USE APPLICAT*k 5ITE9 <br /> 13 MEDICAL WASTE FACUM"f G OTHEr;(PLEASE SPUCIFY) <br /> 1. List Grp to tan addressee in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boiges). At least one file type MIDST be selected. En to( l 1§4.0138 or "e <br /> address indkated above. <br /> 2. EMD will notlNy tho applicant If any EHG flies exist An appointment for review will be conflrmed <br /> approximately five business days but no later than ten(10)days afbw receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not bre immediately available for review. A new <br /> appliaatlon may be submitted when the file is evallable. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHO stiff at the expense <br /> of tte appl(canL Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> a. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8. Applications received after 3:00 pin will be processed the next business day. <br /> CONFIRMED APPOINTMENT GATE TIME <br /> DATE CONFIRMED — -- PRONE FAX INITIALS <br /> REVIEWE=D YES 140 RE1Ili:W DATE <br /> Y <br />