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DEC -13-2004 12:53 EARTH TECH j' 209 532 0773 P.01/0, <br />WE RECEIVED <br />I EHD LOG NUJ r <br />DEP <br />k SANJ0 _4QM COUNTY <br />Lr <br />ENMONMENTAL EULTH DEPART1MM <br />DEC 1 3 2004 = 304E WeberAve 14 Fier. Stocktaa, CA::95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: www.co�.san joaquin.ca.us/ehd <br />PFti rli '`' 1= RV f ,ES PUB -,YC CORDS RELEASE APPLICATION <br />APPLICANT; BUSINESSIAGENCY: �* <br />ADDRESS: A, (). AAv 5V_,14J0R,4 /14 I � <br />FACSIARILE: c�.l.�'rnC� <br />e�6E: X510 - <br />TFNTATIVE;' APPoINTMEAIT DATIv 1-77- <br />f11�� (i'lease 311CW 10 buzlnass days bw date of apP'l11M ion bl) <br />ubftdU <br />29 CHECK SOX TO ExPF-DrrE T- S9300 FEE-- REQU1;S'I' PROGMED IN 3 HUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE j x-744 <br />Department Use only <br />Q <br />Unit 1 <br />L <br />Unit 2 <br />-C� <br />FU H AbDRSSS <br />I� <br />z <br />1 Im <br />�9 !qei <br />Q <br />T 5 CRYPlya <br />Say <br />5- meet <br />CRY <br />a� <br />E sbed <br />b <br />I} <br />L <br />aN "TAM I KF69� <br />(ON ,,,c'a4L <br />, <br />' <br />g. sty <br />f:tc RAi�RO cti <br />33 � G f YI {` <br />UNIT <br />ENVIRONMENTAL HEALTH IDE PARTMENT RLES � � W <br />4' <br />UNDEPGROUND TANK (UST) CLEANUP SITE (L.OP) 4 HOUSING ABATE FNT 4' SOLID WASTE F <br />OTHER CLEANUP SITE (NODI -LOP) 0 FOOD FAC TY ld{ SOLID WASTEsro I <br />UNDERGROUND TANK (fi10NrMRI!'N31REmovAL) I= pOG KENNEL � •� LL4ITtlf <br />FIAZARDOU3S WASTE GENERATOR a CHICKEN RANCH a PKG TREATMENT PLANT <br />T1EPel) FERB rTiED FACILITY 0 MO'TELJHOTEL [] PUMPER 7RUCKIYARWCHEAM TOILETS <br />❑ TATTUOMODY PMRCING L7 POOLISPA LAND USE APPLICATION SITES <br />J? NEDICAL WAs7E FAGILTTY E3 MER (PLf=ASE SPE <br />I� <br />1. List up to ten addresses in the Space above- Select the type(s) of files from the list aboye by cheddnf r <br />the appropriate bOx(es). At least one file type MUST be selected. Fax to (209) 46.4-0138 or mail to the <br />address Indicated above. <br />2• will notify trim applicant If any EHE} files exist. An <br />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 kie scheduled 4 <br />accordingly. <br />3. A file that Is actively being worked on by EHO staff may nat be immediately available for review. A ne+ <br />application may be submitted when the file Is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br />of the applicant Future file reviews by the same applicant may require a $93-00 deposit prior to raviai <br />6. *TENTATIVE appointment dates must be cordirmed with EHDstaff. <br />6. Applicatlons received after 3:00 pm will be processed the next business day. <br />y <br />CONFIRMED APPOiwmE r AAm ... TIME � <br />DATE CONFIRMED 'PHONE - � FAX' INITIALS'' <br />I <br />REVIEWED .. YES NO REVIEW DATE* — - <br />TOTAL P.0' <br />k <br />Q <br />Unit 1 <br />L <br />Unit 2 <br />-C� <br />UnIo <br />Say <br />3 <br />L <br />Unft <br />5� <br />L <br />nit <br />ENVIRONMENTAL HEALTH IDE PARTMENT RLES � � W <br />4' <br />UNDEPGROUND TANK (UST) CLEANUP SITE (L.OP) 4 HOUSING ABATE FNT 4' SOLID WASTE F <br />OTHER CLEANUP SITE (NODI -LOP) 0 FOOD FAC TY ld{ SOLID WASTEsro I <br />UNDERGROUND TANK (fi10NrMRI!'N31REmovAL) I= pOG KENNEL � •� LL4ITtlf <br />FIAZARDOU3S WASTE GENERATOR a CHICKEN RANCH a PKG TREATMENT PLANT <br />T1EPel) FERB rTiED FACILITY 0 MO'TELJHOTEL [] PUMPER 7RUCKIYARWCHEAM TOILETS <br />❑ TATTUOMODY PMRCING L7 POOLISPA LAND USE APPLICATION SITES <br />J? NEDICAL WAs7E FAGILTTY E3 MER (PLf=ASE SPE <br />I� <br />1. List up to ten addresses in the Space above- Select the type(s) of files from the list aboye by cheddnf r <br />the appropriate bOx(es). At least one file type MUST be selected. Fax to (209) 46.4-0138 or mail to the <br />address Indicated above. <br />2• will notify trim applicant If any EHE} files exist. An <br />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 kie scheduled 4 <br />accordingly. <br />3. A file that Is actively being worked on by EHO staff may nat be immediately available for review. A ne+ <br />application may be submitted when the file Is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br />of the applicant Future file reviews by the same applicant may require a $93-00 deposit prior to raviai <br />6. *TENTATIVE appointment dates must be cordirmed with EHDstaff. <br />6. Applicatlons received after 3:00 pm will be processed the next business day. <br />y <br />CONFIRMED APPOiwmE r AAm ... TIME � <br />DATE CONFIRMED 'PHONE - � FAX' INITIALS'' <br />I <br />REVIEWED .. YES NO REVIEW DATE* — - <br />TOTAL P.0' <br />k <br />