Laserfiche WebLink
10/28/2005 10:03 2095224 GEOLOGICAL TECHN10 PAGE 01/01 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2005 OCT 28 Fax:E Veber Ave 3'a Floor Stockton,CA 95205 <br /> (209)468-3434 20 Fez: (209)464-DISH Web:www•co•san joa9Uin•ca•usjehd <br /> SAN iOAQUIN COUNTY <br /> ENYIsoNrt RECORDS RELEASE APPLICATION 1 <br /> yn., ar G4V IQ. Jt, W <br /> \Oq',CA� <br /> ..c, It-r r <br /> .tyrY�l LCSR <br /> APPLICANT! La•�-*''{' C'�o""�' SUSINESSIAGENCY:_ <br /> \O 1 t� TV\ad2sko <br /> ADDRsas: <br /> PNONE: aJ �y „� a <br /> FACSIMILE: <br /> Dq s � � - `I � � <br /> TENTATIVE'APPOINTMENT DATE: i"O t Tkm: v ' <br /> pwasa apb 10 bminws"hom daft of appika submafal) <br /> s�+ CHECK BOX TO EXPEDITE REQ -$93.00 FEE-REQUEST�PROCESSED IN 3 9USINESS DAYS IQ d'1 Q s <br /> SIGNATURE OF APPLICANT \1v x x�r DATE <br /> Deoanmtil uta 07hr <br /> UNIT <br /> FILE ADDRESS <br /> a5 W . os¢rn Unit 1 ` <br /> 2.is S W . �Sa.n+ S <br /> z ., Unk2 1 <br /> a. euae a.b5 W ScYr,:'t4. ` ' ` ❑ <br /> 4. <br /> e SYeM � t <br /> e. sfa.t b 7- " Ur Unit <br /> r slex W . o c ' <br /> e. awe 72'2./0 Oa ^ <br /> t. 9. Sfi. =1 l nk5 <br /> \5\ <br /> fo. _swat e"`• I'Y-%a .) `' YYNL- �g <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ". <br /> 6 UNDERGROUND TANK Nal)CLEANUP SITE ILOP) ❑ HOU87NG ABATEMENT j-3 SOUP WASTE FAG N❑ SOLID WASTE VEHICLE <br /> 91 OTHER CLEANUP sME(NON-LOP) ❑ FOOD FACILITY <br /> a UNDERGROUND TANK(MONITORIW *REMOVAL) ❑ UOG KENNEL ❑ DAIRYPLANT <br /> � HAZARDOUS WASTE GENcRATOR ❑ CHICKEN RANCH C 1 PKG TREATMENT ARD <br /> L] TIED"PERMITTEO FACILITY ❑ MOT EUHOTEL ❑ LAPLIND <br /> u E App IYAMH SITE TOILETS <br /> d TATT00IBOOY PIERCRIO ❑ POOLfSPA ❑ LAND USE AppUCATTON SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the apace above. Select the types)Of files from the list above try checking <br /> the appropriate box(es). At least one file type MUST be selected. '^rorKNt q64 p1 or ma Il to the <br /> add ass indicated a Ve• <br /> 2 EHD wHl notify the applicant If any EHD files exist. An appointment for review will be conDrmed <br /> approximately five business days but no later then ten(10)days atter 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 EHD staff may net he Immediately available for review. A new <br /> application may be submitted when the file is available. EHD staff at the expense4. Any fila not returned III the same condition as released will be reorganized <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 6. °TENTATIVE appoirdm®nt dates must be confimNed with EHD staff. <br /> 6. Applications received after 3;00 pm will be processed the next business day. <br /> LDATP <br /> ED APPOINTMENT DATE TIME <br /> FIRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> wmm <br /> OCT 31 2009 <br /> oCA % ?, 20 <br />