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06/28/2005 11:46 FAX 770 642 0257 RMT INC. ATLANTA U002/002 <br /> 06/24/2005 07:50 4640130 ENVIRONMENTAL H9•t PAGE 01 <br /> RDSAN JOAQU N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, Yd Floor, Stockton,CA.95202-2708 <br /> Telephoue:(209)468-3420 Fax:(209)464-0138 Web:wwwsjgov.org/chd <br /> EWRbNMENT HEALTH. PUBLIC ktECO"S RELEASE APPLICATION <br /> APPUCANT: S or h 6USINFSSIAGENCY: <br /> 2 : <br /> ADDRESS; 1 Ro�eXts y.jyE e. loo A+iaoiy, GA 3o35o <br /> PHONE(1): -11.L. ,Ai-915G 04"i) PRONG(2)• FACSIMft E: 11 O-(042"OZ 51 <br /> TFNTATIWE'ApmwmENT DAm.__-71121 D Tom:-9,0c) AM <br /> (Piease allow 10 business days from date of application auNnittat-'T'entatfve only-must be confirmed) <br /> gyp` 13 CHECK BOX TO E VED(TE REQU T•493.04 FEE(,CA*"OR CHECK ONLY)-REQUEST PROC!_SSED-IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAVE <br /> UNIT OISTWEtMON 0 Unit 1 U Unit 2 s qCnit 4 O Unit s Q Unit 9 a Other(elactmnlclUst- aps) <br /> FILE ADDRESS EHD USE ONLY <br /> street street Name city <br /> 1. 15 esfi I \A Hw <br /> "'Q7 10015 <br /> 2. t' fi a r c u <br /> /9-T)4 or F <br /> 4. <br /> 5. - <br /> -0 <br /> 6. <br /> 7. ' <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range oflnfomtation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDS <br /> I�UQDEMM0um TMK(1,10 CLEAMP"0-M) 0 Kowm IIS mmENT fl souD WAM FkaUTyfVW4 v; <br /> �1 OnrA CLmas 'Srm(NoN-LOP) ❑F000 FACRM 13 WDM TRE <br /> UtOEROROU0 TANK(MMTOWNGIPLAW LL) O DOG MOM Q DAIRY <br /> JS NAZMDouS WA -M GENERATOR ❑Ctocmm RANCH 13 wAsTLwATm TRFAIrUWT PUNT <br /> a Tisa PmumTw FAMM ❑U&M-HOTEL O PtnlreRTRucWAnn/Ct"Ta1LLM <br /> d TATtOOMODY POM0 '13 POC[ISPA 13 LAND WE APPMA"SM <br /> i3 ma mcAL WAsTe PAc&Lm D or'CR(PLEASE sPr <br /> WELL AND SMM PEW&T PZC RDs A!M AVAti.AW-F FOR REvMW- MOHCAY-FF=Y 8-00 AM-6;00rm - EKQJ)n O HOMAM <br /> 1. List up to ten addresses In the apace above. Select the types)of files from the list above by checking the <br /> appropriate box(Os). At least one file type MUST be selected. Fax to(209)464;0138 or mall tot the address <br /> lndlcated above. Address ranges will not ba accepted—for additional assW%nco with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. *he EHD w10 notify the applicant if any EHD files exist. An appointor®nt for review will be canf"irmed <br /> approximately ten(10)days after reoelpt of application. The files will be held for a maximum of five business <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 available for review. A new <br /> atpplication 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 expense of the <br /> applicant. Futuna file reviews by the same applicant may require a$93.00 deposit prior to review, <br /> i <br /> £HO(0-02-0D8 <br /> 41iz M <br />