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:C. 05/03/2005 13:09 2095224. GEOLOGICAL TECHN <br />nc)1MMMDD SAN JOAQUIN COUNW . <br />ENMONWNTAL HEALTH DEPARTMNT <br />MAY 0 17005 304 E Weber Ave 31d Floor Stockton, CA 95205 <br />(209) 468-3420 Fane: (209) 464-0138 Web: wwwxo.san-joaquin.ca.us/ehd <br />ENVIRONMENT HEALTH <br />PEROMERVICES PUBLIC RECORDS RELEASE APPLICATION <br />\\VLA <br />PAGE 01/0 <br />ME <br />as <br />APPLICANT: _ esti r, _W4- BVSINEUTAGENCY: <br />ApDRES$: \ Izi 1 -1-V h S <br />PHONE,• :Lo !1 5 2L a - `i 11 °t FACSIMILE- .; o `1 - S �1-:;- 9 ZL-A--1 <br />TENTATIVE" APPOINTMENT DATE; ���� `•,, <br />Yom' "Cc 6.3 <br />(Plass. allow 10 buslness days from date of appleation submiNiA) apt e w <br />CHECK BOX TO EXPEDITE R(;:�tAEST - ifl3.00 PEE - REQUEST PROCESSED IN 3 BUST �- <br />OS An <br />Department Use Only <br />UNIT <br />p UMt 1 <br />%Hilt 2 <br />Unit 3 <br />Unit 4 <br />Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FI AY �-A <br />■ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) d HOUSING ABATEMENT O SOLID WASTE FACILITY <br />0 WITHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ® SOLID WASIM VEHICLE <br />M UN ND TANK (MONITORINWREMOVAL) ❑ DOG KENNEL 0 DAWY 14 <br />U8 WASTE GENERATOR M CHICKEN RANCH 0 PKQ TREATMENT PLANT <br />E3 TIERED PERMITTW FACn1TY M MOTI=I.IHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILM <br />M TATTOOMODY PK3towe O POOLI8PA ❑ LAND USE APPLICATION SM <br />O MEDICAL. V1/AM FACILITY In OTHER (FLEASE sPV= <br />1. List up to ten Viddresses in the space above. Select the type(s) of files from the Net above by checking <br />the appropriate box(es). At least one file type MUST be selected. ER to (2491464-0138 or maff 19 tlte <br />flddresa indicated above. <br />2. END will notify the applicant If any EHO 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 EHO 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 reorganimd by EHD staff at the expense <br />of the applicant. Future No reviews by the same applicant may require a $23.00 deposit prior to review. <br />6. *TENTATIVE appoinhymnt dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />S. <br />CONFIRME13 APPOIWMENT DATE TIME <br />DATE CONFIRMED PHONE <br />REVIEWED YES NO <br />INITIALS <br />