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12/12/2005 10:51 FAX 9168529118 Geocon Consultants <br /> (6001/001 <br /> EHL):00 NUMBER <br /> DATE RECEIV p- I SAN JOAQUTN COUNTY <br /> G� ENVIRONMENTAL I3EALTH DEPARTMENT <br /> 304 Fast Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Lei 5 Telephone: (204)468-3420 Fax:(209)464-0138 Web:www.sjg0v-0rg/ehd <br /> ENUIRO``�'�rirS�f �Ii���1ti ( 2*q <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BU$INESSIIAGENCY; <br /> PUCANT: - � J 2 <br /> Uf� No <br /> � ADDRESS: 31(.-Po C�olc� UG.-�1P I.-► ter <br /> ULHJ� PHONE(2)1 q t� � 1�(C� FACSIMILE:ENTATIVE`APPOINTMENT DATE: G .�1Time: <br /> (Please allow 10 business days from dote of application submtttal-'Tentative only-must bo conN )K BOX TO MEDRE ES -$93.00 FEE(GAS R CHECK ONLY)-REQUEST PROCESSED IN 3 eU$1NE35 DAYS <br /> DATEOF APPLICANT <br /> TION <br /> Unit 1 ❑Unft 2 O Unit 3 Q Unit 4 Unit 6 Q Other(olactronl0listsJMOPS) <br /> FILE ADDRESS EMD E ONLY <br /> Street# <br /> Street Name Cfky2. <br /> =� <br /> 1. <br /> 4. 0 o <br /> Q <br /> 1110. to <br /> specific Date Range of information Reaueatod:From <br /> ENVIRONMENTAL.HEALT EPARTMENT FILES <br /> C3 ROUSING ABATEMENT -SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND TANK(UST)CLEANLrP StrE{LOP) p FOOD FAGILRY WASTE TIRE <br /> r`OTHER CLEANUP SITE(NON-LOP) ❑DOG KENNEL ❑DAIRY <br /> NDEROROUND TANK(MONITORINc4REMDVAL) l7 CHSCKEN RANG11 �WAMWATER TREATmRNT PLANT <br /> AZARD0U9 WASTE GENERATOR C3 HICK9 RAA 0 PUMPER TRUCKIYPRDICHEM TOILI_r3 <br /> TIERED PERMITTED FACILYfY ❑PM f$PA LAND USE APPLICATION$rms <br /> ❑TATTOOIBODY PIERCING ❑OTHER(PLEASE SPECIFY) <br /> E3MEDICAL WAaYE FACILITY <br /> AVAILABLE FOR REVIEW- <br /> w6Lt AND SEPTIC PERra(r RECORDS ARE MONDAY-FRIDAY 6:00 AAtti`:ODPM - frycr,UDINO HOUDA J. <br /> 1. List up to type(s)of files from the list above by checking the <br /> ten addresses In the space above. Select the to the <br /> appropriate box(es). At least one fila type MUS � ela rdadditionaI assistance ce with file64-0138 or mailaddresses,contact <br /> indicated above. Address ranges will not be accepted <br /> the HEthe HE p Applications received after 3:00 pm will be processed the next business day. <br /> nt for review <br /> 2. The EHDiwa will nen 1the 0)dpplicae receipt oDapplication.lThe fies exist. An les wll®be held for a m�axill bm m of five business <br /> approximately ( <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avaliable for review. Anew <br /> application may be submitted when the file is available. the <br /> 4. Any file not retumed In vheeMsa be condition the Ppreleascant d will b ire reorganized <br /> X93 00 deposit prtorfttotrevlew expense of the <br /> applicant. Future ere Y <br /> EHD 4e42-00 <br /> 1NMOC <br />