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03/23/2004 TUE 10;56 FAI 916 5654356 4001/001 <br /> 02/17/2004 15:32 4640138 DWIRORENTAL FEALTH PAGE 02 - - <br /> DATER_ECEtVEII .- _ �+,��••,••^^---• <br /> SAN JOAQUINCOUNTY <br /> ENVIRONMENTAL$EALTH DEPARTMENT <br /> MAR 2 2004 304 E Weber Ave a Floor Stockton,CA 95205 qj <br /> (209)468-3420 Fax:(209)464-0138 Web:www.co san Joaquin ca ustchd <br /> 1t1V 1 HEALTH <br /> RVICES PUBLIC RECORDS RELEASE APPLICATION <br /> AMICAHt: =lNgSS,AGENCY: <br /> ADDMS: 13� <br /> PHONE • J to�-_'l �Q `P FACSIMM <br /> TENTATIVE'APPOWfMENT DATE: Tkne: <br /> n <br /> rk�sit**1t1 Iut9ieass days hem data of Epp6casw E 0 <br /> 0 <br /> a: <br /> CHECKBOX TO EXPEORE REpQUEST-$SIM FEE-REQUEST PROCESSED N 3 EUSNE.SS � ..A <br /> SicNATUREOFAPPOCAHTDATE <br /> 0* <br /> FLLEAWRESS - UWr <br /> P,. e f 1 gqO 1 G evnQ �S ❑ Una 1 <br /> 2 d I <br /> 3 gmg Ljoi cgoU Unit2 -31-0 <br /> ,. EAICI -T d010, ,1 <br /> sme Unit 3 Y( <br /> 6, toad <br /> T. Ned <br /> 0. WOO <br /> r• sere ��� ❑ Units <br /> ta. aeaCAN <br /> EwRONMENTAL HEALTH DEPARTMENT FILES <br /> I r-UNDEROROUM)TANK MT)CLEANUP SITE(LOP) O HOUSING AHATEMEN7 ❑ SOLIO WASTE FACII-TTY <br /> ,S'OTHER CLEANUP SITE(NON-LOP) U FOOD FAULM ❑ SOUo WASTE VEM LE <br /> UNDERGROUND TAW(MONI ORMIREMOVAL) O DOG Ia=NNr.I. O 9NRY <br /> HAZARDOUS WASTE GENERATOR 17 CHMNRANCH O PKOTRFATWKTPLAHr <br /> Q TIERED PERMITTED FACRRY M MOTELAAOTEL ❑ PUMPER TRUCK1YAPIWOMM TOM TS <br /> - ❑ TATT00AMYNERcNG ❑ POOL/SPA In LANDUSEAPPLIcAT10NSITES <br /> ❑ MENCALWASTEFArAMY E3 OTHER VLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)of Iles from the fist above by checking <br /> the appropriate box(es). M least one file type MUST be selected. Fax to QW)4s4-0138 or mal to the <br /> address indicated above. <br /> 2 EHD will notify the applicant If any EHD files exist. An appointment for review will be eonfimned <br /> approximately five business days but no later than ton(10)days after receipt of application. The Tiles <br /> Wili be held for a maximum of five business days for review. Appointments should ba 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. rn{p {{at the expense <br /> 4. Any file not returned In the same condition as released will be reorganized by <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTAT NE appointment dates must be confirmed with EHD staff. <br /> s. Applications received after 3:00 pm will be processed the next bus(nesa day. .. <br /> Z3NF fiU)16UlidAbttiil�i N1 A - T11ME <br /> 'w <br /> •i�AT6G�Nif•',1i,21I1��D' <.'.• ';PF)OHE'= FAX'' ' zlr�t(f�lE1LS'' �..•.: tia�- , <br /> '{2�VIYVEI) •YES REVIEW DATE <br /> Eno vasa a - <br /> r ,��-FIQC,�(i•� (t In i <br />