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Aua -25 . 2003 120P , COP, EARTH TECHNOLOGIES No .4748 P . I/I <br /> Qa�r KI <br /> OA7E AErRVm ENG LOG NUMUR <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 'WC2 5 c003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCK70N CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTf a- q%4J_A*Z,_81.13INE1ySSSIA'GENCY �>^-�Y,; ,� �Oa •I <br /> ADDRESS 1966 �Y (M `lir, (AJ-�S�T <br /> PHONE ZL� FACSIMILE r�-•�`-1� <br /> TENTATIVE'APPOINTMENT DATE '•I//�IV 5tos TIME <br /> (Please qve 7 to 10 6Usiness d4jol from data of appllcatlon submHtan <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAYS ' <br /> SIGNATURE OF APPLICANT DATE -0 3 <br /> c <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> U=� PR G qNT3 SEARCH <br /> Sao v C_V_1-or ✓ • <br /> r <br /> ao O ✓ <br /> 020 <br /> 19 <br /> vLa . / <br /> Ave . <br /> ­7711k4 <br /> �/ ENVIRONMENTAL HEALTH DIVISION FILES LSD <br /> '44 rr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINGABATEMENT SOLID WASTE FACILITY AUC 26 2(' <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONfrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERHrrTED FACILITY ❑ MOTELMOTEL 0 PUMPERTRUCKIYARD/CHEMTOILETS <br /> TATTOWBODY PEIRCING ❑ POOL!$PA 0 LAND USE APPLICATION$fans <br /> MEDICAL WASTE FACILITY PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <br /> 1• List up to ten addresses in the space above.'Select the type(s) of files from the list above by checking <br /> the appropriate box(es), At)east one file type MUST be selected. Fax to (209) 464-0138 or mall to the <br /> address indicated above. <br /> 2. END will notify the appficant if any END files exist. An 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 be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new <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 END staff at the expense <br /> Of the applicant Future file reviews by the same applicant may require a $87-00 jkpr¢9r <br /> 5. 'TENTATIVE appointment dates must be-confirmed with END staff. 9 <br /> s. Applications received after 3:00 pm will be processed the next business day. S <br /> CONFIRMED APPOINTMENT DATE TIME <br />