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04/06/2005 09:56 FAX 209 9480E <br />002/002 <br />C.lL MVV IYlil�fut-., <br />DATE FECEIVED SAN J OAQULLN COUNrY <br />HL� � �1 lJ ENYXRONN ENTAL MAL- . DEFAR.TmENT <br />304 E Weber Ave 3`1 Floor 5taekton, CA. 95205 <br />6 70001-09) 46$-3420 Fax: (209) 464-0139 Web: www.co.m-joaquia.caus/ebLd <br />J&3q7 <br />ENVIR0NM NT HEATH PUBLIC RECORDS MLEASE APPLICATION <br />APPLICANT: �3�� HUSINESSIAGENCY. ft <br />�K U[� <br />ADDRESS; <br />PHONE; 6 -LCA) FACSIMILE: <br />TENTATI lt- APPOINTMENT DATE. hTime; I <br />(Please allow 10 business days from date of application submittal) <br />CHECK BOX TO V PEDfTE REQUEs-r-$93.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT pA7E_ <br />Depoftment Use Only <br />ENVIRONMENTAL HMTH DEPARTMENT FILLS <br />UNfr <br />❑ Unit 4 <br />Unit 2 <br />Unit a <br />2(} Unit 4 <br />❑ Unit 5 <br />UTIDERGROUND TANK (UST) CLEANUPSITE (Eopl U HOUSING AeATEMF-Kr UL Soun WASTE FACILITY <br />o'TFiER CEEPANUP SITE (NON -LOP) C] FOOD FACILITY t.7 501.10 WASTE VEHICLE <br />a UNDERGROUND TANK [MaNITOWNCVSMOVAL) ❑ DOG KENNEL IS- DAIRY <br />STCI CHICKEN RANCH 19L PKG TREATMENT PLANT <br />1�1 F{AZACiL1pU5 WASTE GENERATOR C1 MOTELPNQTEL ClPUMPERTRtJr- KIYARnicHEM TOILETS <br />r-3 TIED PERMrT FACILITY <br />C)TATTOO/©00Y PIERCING ❑ POOLISPA a I ANS IJSE APPLICATION SITE$ <br />0 MEDICAL. WASTE FAGILIYY ❑ GTHEP (PLEASE SPECIFY) <br />1. List up to tan addresses in the space above_ Select the types) of files from the list above by cheeicing <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. EHO will notify the applicant if any EHD files exist. An appointment for review Will be cortfrrmed <br />approximately five business days but na 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 an by EHE) staff may not 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 revie` <br />5. 'TENTAME appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm wilt be processed the nextbusiness days <br />GONFRM P.P <br />NTAAE�,Al'E' : x _ . TIME ;„aw K: .; : ;:�•:s_°� <br />_ D: POINT-.Y.:s�d=''M-�. -,. ;��,.ti,5:�.�,a••'�;'`:,,,. <br />SDATECONFIRMED RHONE FAX :�lNCT1ALs ��' <br />REVIEWED YI=S NO REVIEW DATE <br />