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✓01/0212004 12:09 FAX 209 94806— @1002/002 <br /> v DATE RECEIVED <br /> n (�I�\\// ,*W SAN JOAQUIN COUNTY <br /> W E C Lc U V E P ENVIRONMEN'T'AL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3nd Floor Stocktort,CA 95205 n <br /> MAR 0 2 2004009)468-3420 Fax: (209) 464-0138 Web:www.cosanjoaquin.ca uS/ehd `F J/ <br /> ENVIRONMENT HEA [H PUBLIC RECORDS RELEASE APPLICATION <br /> PCD A IT/C crz�ticE <br /> APPLICANT:—YJt..S �?A�. S".BUSINESS)AGENCY:_ <br /> ADDRESS:_ LIb-2_c r <br /> PHONE:_ _I►E11L00' 1..LC' FACSIMILE: •�kf7 66I t <br /> {; <br /> TENTATIVE'APPOINTMENT DATE:_ 3'I I�� Dy Time: 17 LID <br /> (Please allow 70 business <br /> days tram date c(applic0on submittal) n <br /> I' <br /> ❑ Ii Y 3� <br /> CHECK BOX TO EXPEOtTE REQUEST-$97.00 FEE--REQUEST PR ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 <br /> Deoartnlerd Use Only <br /> EI FILE ADDRESS <br /> UNIT <br /> • ,. s� a..D S 1. �/ WO <br /> • z. wren �)tr.q� O Unit1 <br /> a. sees Iq3 s jjoUnR4 <br /> 2 <br /> 4• seen 2 % . t.0 \j <br /> s. ssa ' S t +.�. �I / I <br /> ' <br /> • T. saes M Lo Ste. � <br /> s a. assnI CA t to- u N4 00 LUU <br /> Shy I' CON UR 12 004 ❑ Una e 41MW <br /> sinCW <br /> i ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A( UNDERGROU I D TANK(UST)CLEANUP SITE(LDP) ❑ HOUSING ABATEMENT SOLID WASTE FACILrTY <br /> G[OTHER CLEA� Qi UP SRE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> to UNDERGROUYD TANK(MONtrORINGIREMOVAL) ❑ DOG KENNEL tU DAIRY <br /> la'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELAIOTEL ❑ PUMPER TRUCKNARD(CNEM T0b_ETS O <br /> ❑ TATTOOIBODii PIERCING Q POOLISPA 8 LAND USE APPLICATION SITES <br /> CIMEOICAL WASTE FACILrry ❑ OTHER(PLEASE SPECIFY) <br /> 1. List v p to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box($$). At least one file type MUST be selected. Fax_ to(209)464-0138 or mail to the <br /> Address indicated above <br /> 2- EHD,will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> appjoxlmately 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 EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. An .file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of ffjLe applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> fl <br /> .j; L1AE'...r._ _F : TIME '7• ^,:dy':.. ' :1e._.' <br /> '.04T -CON1=lWED PHONE FAX Tv'--zltJfrtlQ�3 - <br /> EE <br /> .REVIEWED YES NO REVIEW DATE,' <br /> GM <br /> Mai 1, <br /> vriaoa <br /> f - <br />