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RUG -23-2004 15:51 C&R EARTH TECH I 0 209 532 0773 DATE RECEIVE � f SAN JOAQM COTTNTX �j E+ NYmo_NMENTAL HEALTH DEFARTWNT PUG 3 2004 304 E Weber Ave Yd Floor Stocklon, CA 95205 ((2 468-34N Fax: (209) 464-0138 Web: www,co,san joaquin.ca_us/ehd ENS RanN7 S`ER� C �� PUBLIC RECORDS RELEASE APPLICATION EHD LOG NUI R lqbw*7 ri � O. .: .I� 1� � ,¢ w • 'P (-• pY%J�$ 47 4 Time: 71 ' a" 4,m -- TENTATTW APPOINTMENT DATE (Please allow 10 businm days from data of application submittal) CHECK BOx TO ECPEDrm RE VEST - $83.00 -- REQUEST PROCE3SE0 IN 3 BUSINESS DAYS SIGNATURE; OF APPLICANT DATE ✓/ ✓iv ✓✓ ✓/ ENVIRONMENTAL HEALTH DEPA%V NT FILES*-? .0-4Co Deaartrnant Use OnIV 9100 UNIT ❑ Urft 1 A UnR2 Unit 3 Unit 4 D❑ Unit 5 nK In' UNDERGROUND TANK (UST) CLEANUP SITE (LOP) q HOUSING ABATEMENT (Pr SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY *r SOLID WASTE VEI-NCLE Qd, UNDERGROUND TANK (MONITORINGIREMOVAL) U DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT TIERED PERMITTED FACILrrY 13 MOTEIRIOTEL d PUMPER TRUCK/YARDICHEM TOILETS 0 TATTOOMODY PIERCING Cl POOLISPA Pi' LAND USE PPPUCATION SITES t7 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIET) 1- List up to ten addresses in the space above. Select the type($) of files from the fist above by aheckin the appropriate box(es). At least one file type MUST be selected. Fax to (709) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A ne application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the experts of the applicant- Future file reviews by the same applicant may require a $93.00 deposit prior to•revie 5_ 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS' I REVIEWED YES NO REVIEW DATE TOTAL P -a +3-0( 4 554 61 (),),-ado U5 t F e, ed is P./ir. I� • "rim .�r.11 WX,.... _ fig WE rl i • .w.mau�w�wt'7to ENVIRONMENTAL HEALTH DEPA%V NT FILES*-? .0-4Co Deaartrnant Use OnIV 9100 UNIT ❑ Urft 1 A UnR2 Unit 3 Unit 4 D❑ Unit 5 nK In' UNDERGROUND TANK (UST) CLEANUP SITE (LOP) q HOUSING ABATEMENT (Pr SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY *r SOLID WASTE VEI-NCLE Qd, UNDERGROUND TANK (MONITORINGIREMOVAL) U DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT TIERED PERMITTED FACILrrY 13 MOTEIRIOTEL d PUMPER TRUCK/YARDICHEM TOILETS 0 TATTOOMODY PIERCING Cl POOLISPA Pi' LAND USE PPPUCATION SITES t7 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIET) 1- List up to ten addresses in the space above. Select the type($) of files from the fist above by aheckin the appropriate box(es). At least one file type MUST be selected. Fax to (709) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A ne application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the experts of the applicant- Future file reviews by the same applicant may require a $93.00 deposit prior to•revie 5_ 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS' I REVIEWED YES NO REVIEW DATE TOTAL P -a +3-0( 4 554 61 (),),-ado U5 t F e, ed is P./ir.