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EHD LOG NUMBER <br /> nATE RECEIVED SAN JOA.QUIN COUNTY <br /> 1"1 Lt- E`NVIRON1VZENTAL HEALTH DEV",'RT�t,�NT <br /> u , 304 E Weber Avc 3 Flaa>• tocl~rtt�n, GA 95205 <br /> (209)468-3420 Fax: (209) 4614-41.38 Web: www.co.san-joaquin,ca.-us/eh <br /> MAR 1 G 2006 22004 <br /> n PUBLIC RECORDS RELEAS <br /> E APPLICATION <br /> � APFL[GATlTlrlv`. � 1 r�S r HU51N7=55fAGENCY: 1 1 V n r f.(`,Sri c,Jf U C <br /> PHONE: V-! / l J l FACSIMILE: <br /> TENTATIVE'`APPOINTMENT DATE: ;roe- <br /> loase allow 10 b iness days from date of application subriltW) <br /> © CHECK 13OX Tb EXPEDITER GLUE T-$53.00 1 -REQUEST PROCE5S7b IN 3 BUSINESS DAYS <br /> S1GN,A'Tl}RE OF APPLICANT DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. svicet 1 pC GLF unit i <br /> 2. Slrest <br /> 3, S rrgl City Unit 2 <br /> A. Slr*et Gt �� o <br /> 5. 3trC^_I Ci - 0490pu C. <br /> cits. Sum <br /> 7, s,rcer at �Unit 4 <br /> 01 <br /> e, slmnl <br /> DIV ❑ Unit 5 <br /> 2. Strew <br /> Gu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT © SOLID WASTE FACIL7Y <br /> r OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL, n DAIRY <br /> CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> �]iAzARDoUs WASTE GENERATOR C] MOTELIRAN 0 PUMPER TRUCKNARDICHEM TOILETS <br /> �'TIERED FERMfTTED FACILITY [D pO0U5PA 171 LANA USE APPLICATION SITES <br /> n TATTOOIaODY PIERCING ❑ OTHER(PLEASE SPECIFY] <br /> X M'EDiCAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files frorn the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-4133 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 /> approximately five business days but no later than ten (10) days after rece'lpt of appliCition. 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 baring worlEtd on by EHD staff may not be Immediately available for review. Anew <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 expense <br /> of the applicant. f=uture 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 3:04 prn will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CON51RMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ = <br /> EHD 40�0240G <br /> 8l817.OR3 <br />