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05/03/2005 13:09 209522i� 7 GEOLOGICAL TECHr"s PAGE= 01/0 <br /> END LOG NUMBER <br /> n��� SAN JOAQUIN COUNTY } <br /> ENVTRONAWNTAL HEALTH DEPARTMENT g <br /> N4 AY Q,..1 7005 344 E Weber Ave 3 Floor Stockton,CA 95205 <br /> 17 <br /> (209)469-3420 Fax; (209)454-0138 Web:www.co.san-}oaquzn.ca.us/ehd , <br /> ENVIRONMENT HEALTH <br /> PEUOTfSERVICES PUBLIC RECORDS RELEASE APPLICATION ---Fj <br /> APPLiCANy':__�e.r.Tj j 1,&) ,mac.. ._i BU INE9SIAGENCY: -1D 1° ,; e-e.I �C.c}a.,.cr ,��•_ <br /> ADDRESS:, 110 At <br /> — <br /> PHONF. - `') 11 FACSINLE: :16 O <br /> TENTATIVE"APPOINTMENT DATE:_w;�1 d o*, ,les TIm.: °"� ,•� <br /> TO <br /> (Flame allow 10 buminsss days from daft of■ppllcatkm auhn*w) <br /> cTOL4-V- w:\\ V-W- tra;�ek s-3-05 <br /> CHECK BOX TO EXPEDITE REQUEST-"3.00 M-REQUEST PROCESSED IN S BUS114ESS DAYS } P'm <br /> SIGNATURE OF APPLICANT � � t EE 5 r zl p 5 <br /> + 1 M Depeftneit Use Offt <br /> FILE AMIRESS UNIT <br /> ,. aftm W. GrN a Tr i�' <br /> z sit 5 5 G c-c aftfi L,riQ- Tra i tt A--,- <br /> D Unit 1 <br /> srrael 5 L G rwT'kW �- T r N 4*- ,�FIit 2 <br /> 4, sm S-1 S W . ;rt ra.c <br /> C 8"M a:3-15 Trw lvoL LN fa4 Unita <br /> T. ETW Unit 4 <br /> a. <br /> e. ' Unlit 5 <br /> 1G. srmc <br /> r <br /> ENVIRONMENTAL Hi=ALTH DEPARTMENT FILES <br /> ■ UNDERGROUND TANK(U"CLEANUP BITE(LOP) d HOU81NO ABATEMENT O SOLID WASTE FACILITY <br /> ■ 07HER CLEANUP>NTE(NpN.LOP] ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDOWROUND TANK(MONITOWN31REMOVAL) ❑ 000 KENNEL 13 DAIRY <br /> ■ HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH G PKQ TREATMENT PLANT <br /> ❑ TIERED PMMffTrpD FACILITY O MOTFl MI. 13 PAMPER TRUCKIYARD A TOILETS <br /> M TATTOOIBODY PIERMO ❑ POOLISPA 4 LAND USE APPLICATION 81TFS <br /> 0 111EDICAL wA&M FACILITY 17 OTHER(PLEASE SPacat:Y) <br /> 1. List up to teen sddressee in the space above. Select the type(s)of files from the list above by checking <br /> the approprbite box(es). At least one file type MUST be selected. Fax to(2091544138 or maw e <br /> address Indleated 11boYe, <br /> 2 EBRD will notify the applicant If any EHO files axlst. An appointment for review will be confirmed <br /> approidmately five business days but no later than ton(10)days after necelpt of application. The files <br /> will be held for a ma)fmurn of five business days icor review. Appointmemx 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 reorganbred by EHD staff at the enw-me <br /> of the applicant. Future file revlews by the same applicant may require a$93.00 deposit prior to review. <br /> !l. "TENTATIVE appolntment dates must be confirmed with EHD staff. <br /> 0. Applications received after 3:00 pill will be processed the next business day. <br /> CONFIRME13 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ereranw <br />