Laserfiche WebLink
05 / 03 / 2005 13 : 09 20952 ' 27 GEOLOGICAL TEC CS PAGE 01 / 0 <br /> 11nD DD 11 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 7 g <br /> t w 304 E Weber Ave 3 ' Floor Stockton CA 95205 <br /> AY © � ? 005 (209) 468-3420 Fax: (209) 464-0138 Web : wwwoco . san"JeOuquin .ca. us/ehd <br /> ENVWRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION < <br /> APPLjCANT: _.. �nx,�1 W wo, BUSINESS/AGENCY; to <br /> AADRES9: _ 1 1 L. S <br /> PHONZr' d 13 D. a - 'l k FACSIMILE: a o 91 _ S 't)kW ra.� y i <br /> TENTATIVE" APPOINTMENT DATE: W;\'� cJ� v�Lj. o VN <br /> _ Tuns: <br /> (Plsaso allow 10 business days from date of eppllcation submittal) <br /> rev t •ew T1r` S , <br /> CHECK BOX TO EXPEDITE REQUEST - $98.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'W JQ.DI rE 12 I o S <br /> uDepartment Use OnIY <br /> FELE ADDRESS UNIT <br /> i. '� 1 �W • G r q rtr ¢M 1� p Unit 1 <br /> 2, Street 15 rG,ht I— ; t% o, Tr' 0. 4 { t •}^-L- <br /> street S `11 G ra,%�t W 'Tr 2 <br /> 4, auem ^t 5 �r.1 o..ti a1 r �. C { <br /> 6, ou" a -i S TCA �V ok, N ) CRY a4 e Unit 3 <br /> a. sueet 15 y 4 c o L, n �(� r c� SS 4. <br /> 7• SVAW CAN Unit 4 <br /> so aveel <br /> a. Unit 6 <br /> 10. Sinal G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$. <br /> ■ UNI)MOROUND TANK (US10 CLEANUP S" (LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ■ OTHER CLEANUP SITE (NON-LOP) D pOOD FACILITY o SOLID WASTE VEHICLE <br /> IB UNDRKGROUND TANK (MOWTORINGMEMOVAL) ❑ DOO KENNEL ❑ DAIRY <br /> 6 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKQ TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOT>..I.IHOTEL ❑ PUMPER TRUCKIYARDK;HEM TOILETS <br /> 0 TATT'OOBODY POMNO ❑ POOLISPA 4 LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY G OTHER (PLEASE SPI=CIFY) <br /> 1 . List up to toll addresses in the space above, Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type FAUST be selected . Fax to (2091104±)138 or =11 tQ jhe <br /> pddms indicated above. <br /> 2. EHD will notify the applicant If any EHP 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. Appointments 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 /> 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 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 /> ti. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIMI; <br /> DATE CONFIRMED �. _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FW 4"UN <br /> srortGoa <br />