Laserfiche WebLink
4 <br /> 10/28/2005 10:03 2095224i' GEOLOGICAL TECHN' PAGE 01/01 <br /> a_mD LOG HUMBER <br /> DATE REC>=1VED SAN JOAQUIN COUNTY <br /> ENVIRONMMNTAL HEALTH DEPARTMENT <br /> 2045 OCT 28 AM 9'3E Weber Ave 3 Floor Stdctctott,CA 955 t us/ehd <br /> (209)468-3420 Fad: (209)4(> an j <br /> 4-0138 Web:www-00.soar4ui <br /> 5 r ;O=,CL113 cOUNT Y <br /> "IV l�; <br /> OHM- RECORDS RELEASE APPLICATION <br /> W <br /> ttsx <br /> APPUCANTc lro�.,�r-:e.. S�ae•c. - 8u8iMEs8fA(iEfi1CY: i S <br /> ADDRESS: <br /> `I <br /> PHONE:E: <br /> °t � - 11 1 FAGSOULE: a-° 5 a. 11 <br /> TENTATIVE'Appolpf'ra EXT DATE:�t� _ v TM": r <br /> tPaoasr aE1v.►0 husinwe days fmm daft of appikot m submkW) <br /> Cma.tal IQ 1 x,j Os� <br /> CHECK 13OX TO EICPIRWTE REQ -$OAO FTSE—RECUEST PROCESSM 1N 3 IIU81NE"DAYS r O d.'� Q s <br /> DATE <br /> SIGNATURE OF APPLICANT is m U"OF* <br /> uNrr <br /> F"ADDRESS <br /> ~YYNch in L1 Unit 1 <br /> ,. N-, \/6 <br /> OSc.m s ., <br /> a. saaw �,b 5 W . Sa-�r*+:'CQ• ' ❑ UnK 2 <br /> a. „ I <br /> S a <br /> 1:;filt <br /> 3 <br /> 14 , a tio. t5 flSiS. <br /> 2� <br /> i Sfi. L.' <br /> to. wast rvN z) i <br /> EtMRONIVIENTAL HEALTH DEPAITIVIENT FILES <br /> sass MWERGROUK0 TANK(UST]CR.EANUp at1TE(LOP) O 3tUt18iNG ABATFJIfENY a7 SOLID WASTE FACIE? <br /> * OTHER CLEANUP SITE(1401440p) ❑ FOOD FACRJTY D SOLS WASTE 1rEFfICLP <br /> * UNDEMROUND TANK(MIQWTORIkQ vAL) 0 DOG KENNEL ❑ VA KY <br /> 46 HAZARDOUS WIA rM GMrN ;RATOR 1a CHICKEN RANCH 0 PKG TIMATMENT MAW <br /> C1 TIEREa3 PE�IAITi1=D FAf�LrIY a MOTELMQTEL (3 PUMPER TRUCKIYARMHEIII TOILEm <br /> 13 TATTOOMOV PIERCINQ a 7 POOLISPA o LAND USE APPLICAY30Aa SM" <br /> o wDICAL WASTE FAMLITY 0 oTHER(PLEASE Sp <br /> 1. List up to ban addresses in the space above. Select the tyPOW of files from the list abIove by Checking <br /> the appropftote boAets). At least one file type FAUST be selected. Fax to LM)4"-0'i or Mgfl to thg <br /> saidfessIndis"akzove, <br /> 2. EHD wul Iwtffy the applicant If any(=HO files wrist. An appolrltFn9Rt fOr MVI0w yrltl be'cOnflrma�d <br /> approximately ft"business da"but no later then ten(ill)days after receipt of apPlicaopn• The flies <br /> wilt be held for a mea mum of flve business days for review. AppohttnIsnts should las scheduled <br /> accordingly. <br /> S. A file that Is actively being wo"d on by EHi)staff may not be tfnmedlatsly available for review. A now <br /> iapplica;tkm May be subrrtkW when the file Is avallable. <br /> 4. Any fila not agt,trtaad in the same Condition as roleased will ��r�a�9nh ed�!�doh P��is'"'- <br /> of the applicant. Futuro file reviews by the saltie atpp' m ag►� <br /> 6. *TENTATIVE appolntamnt chiles must be confirmed Wilde IEHD staff. <br /> 5. ApplicatlWna received after 3:00 pm will be processed the next businmw day, <br /> CONFIRMS=D APPOI+ITS IEW17 DATE TtM <br /> DATE C0NFIRMED , {SHONE FAX INITIAL$ <br /> REVIEWED YES NO RU%gP EW DATE <br /> dsrlom <br /> OCT 31 200 <br />