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Dec. 16 201�`"a 01:39PM P1 <br /> FROM Ground Zero Analysis PHONE NO. : 209 63 986 <br /> j I EHO LOG NumBER s <br /> SAN JOA.QUIN COUNT)( it <br /> 2.005 ENVIRONMENTAL REA.LT11)DEFART�1'1EN <br /> v 1; T <br /> 304 E Weber Ave P Floor Stockton.,GA 95205 <br /> X68-3420 Fax: (249}464-0138 Web:www.co.san joaquaz.ca.us/sizd <br /> it �l <br /> PR�+�11Tt5ETtV1CS Uj3LIC RECORDS RELEASE ApPLICATXON <br /> 1 APFUCANT: gU51NSS$1AGEN : } <br /> ABDRESS: <br /> a 8 FACSIMILE: i3 J q <br /> PHONE• <br /> TENTATIVE"AppOINTMENT DATE` T9�rie: <br /> (Please allow 10 buftew days from�°f appiicativn submittal) <br /> C MCK BOXTO EXpFLM REQUEST- 43..00 FEP—MQUEST pROCESSM IN 3 8111I iNESS `DAYS <br /> !I iR _ [)ATE <br /> SIGNATURE OF APPL.1CANT Dapartmnt Use Only <br /> fit UNIT L <br /> FiL b a > <br /> Unit 1 <br /> zqhy s, © Unit 2 <br /> Unit 3., ., ) <br /> 6- 86es1 IFFI <br /> .N $ <br /> �. sneer k. ti r <br /> >s easel I ;M ❑ Unit 5 <br /> EtWRONMENTAL HEALTH DEPARTMENT ALES <br /> yLITY <br /> MERGROUM TANK(UST)CLEANUP SITE(LOIS) 0 HOUS114G ABATEMSHiT 0 SOLID WASTE VEHFACICLE CLE <br /> GY��f Cl EA1dUP SrM(NON-LOP) 0 FOOD FAOLFry 0 'DAUD WASTE 11EH[CLE <br /> DOC KENNEL I A ;DAIRY <br /> tQ NDERGR4UNDTANK(IViON1TOE2iNG1FtENlOVAL) i C IPKGTREATMENTPLANT i <br /> [VHAZARDOUS WASTE GENERATOR A CFIICKEN RANCH �i 0�PUMPEP TRUCKIYARDICHE[�I TOILETS 1 <br /> 0 TIFF p�tr�D FACILITY Q MOTELI 3OTEL <br /> TAC 00lBODY pIERCTMG 0 POOLISPA 1'3 `I ABED USE APPLICATION SITES <br /> M'MIMTCAL WASTE FACILITY D OTHER(PLFASE SMI i j <br /> �( M checitirt <br /> 1, <br /> LW up to ten addresses in the space above. Select the type(s)of files from the list above by 9 <br /> the appropriate box(es). At least one file type MUST be selected. Fj-k to 209 464-0138 or mail to the <br /> address ndicate<#aboye_- <br /> 2. _ EHD wi#1 Hardy the applicant if any EHD Flex exist. An atapointmsnt 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 m2Amum of five business days for review• i�ppoi is>hhttents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by =HD staff may not!e imm' lately available for review. Anew <br /> application may lie submitted when the file is available. II ! <br /> rganiaed by EHD staff at the expense <br /> 4. Any file not returned in the same condition as released will be rea <br /> of the applicant. Future file reviews by the same applicant may re ire a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be Confirmed with EHD staff. i� <br /> 6. Applications received after 3:00 pm will be processed the nekt busli ess day. <br /> CONFIRMED APPOINTMENT DATE TIME 'L <br /> PATE CONFIRMED 11 <br /> FAX I iNrrIALS <br /> REIfIEYVSD YES NO REVIEW DATE <br /> areriocs <br />