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°Fmn'lL,-,TR Environmental PHONE N0. : 209 369 4228 in. 11. 2003 11:05RM P2 <br /> SAN JCOUIN COUNTYPUBLIC HEALTH S)RVICES °MOSocNUMBER <br /> ENVIRONMENTAL HEALTH DIVISIcm <br /> JUN 1 .1 2003 304 EAST WEBER AVENUE,THIRD 1=1_0014 <br /> ' STO{;KION CA 95202 <br /> ENVIROfd'MENT HEALTH (1!09)468-3420 <br /> PERMfT SE Vr S PUBLIC RECORDS RELEASE APPLICA'P'IO1d <br /> r�1 <br /> APPLICANT `y / r7Gcll ( BUSIMMSIAGENCY ���j �✓r s" ��_��� _� <br /> ADDRESS <br /> PHONE Lzo�%7--370/ FACSIIIILELW953G7— `f.:Z$ <br /> TENTATIVE'APPOINTMENTDATE �IIL,I ref-yO'--�J---� TIME <br /> (Pleaw give 7 to 1 bbuslo ! ayse from date Of applfcatiOn submit[IJ) <br /> CHECK BOX TO EXPEDITE REQUESTT 9 FEE- QIIEST PROCESSED IN 1 Bl1S1NE;i5 DAN"', Vul'�J3 >t <br /> SIGNATURE OF APPLICANT DATE <br /> J <br /> FILE ADgRESS T'H13 SIDE @ HOSTAFF USE ONLY /� <br /> PR OG RANI ELEMENTS'SEARCH (vl. <br /> �erlo Pro 93(o Sdnc �01 • _ �/ <br /> 'A 04ps DQO t4C m / •L <br /> 'hDGKfv+l -. <br /> v DD <br /> \ , e 1 <br /> o w V <br /> ENVIRONME?NT,E1L HEALTH DIVISION FILES <br /> 1�UNDERGROUND TANK(UST)CLEANUP SFI E(LOP) ❑ HOOSING ABATEMENTCS <br /> Cl ;IOLIC-WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLJIC WASTE VIEHICUr <br /> aT UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DCX;KENNEL CI (iAIR1' <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHF,KEN RANCH 11 F'KG I RCATMeNT PLANT <br /> ❑ TIERED PERMn1ED FACILRY ❑ Mo'EL OTEL C1 PUMIr I.RTRIICK!YARC/CHEM TOILETS <br /> ❑ TATTOOIRODY PEIRCWG 13 POOLISPA CI LAND NSE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUF LIC WATER SYSTEM [I ()THE::(PLEASE SPECIFY ADONIS) <br /> 1. List up to ten addresses in the space above, Select the type(s) of files fro n the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fox to >09 d64-g138 or mall to the <br /> address indicated above. _— <br /> 2. EHD will notify the applicant if any EFID files exist. An appointment for re-riew will be confirmed <br /> approximately five business days but no pater than ten(10) days afler rec0pt of applicaCion. The files <br /> will be held for a maximum of five business days for review. Appointinents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by FHD staff may not be Immediatel V available for roview. .A new <br /> application may be submitted when the fit is available, <br /> 4. Any file not returned in the same condition as released will be reorc)anizotI by EHD staff at the expense <br /> of tho applicant. Future file reviews by thft same applicant may require a 589.00 deposit:prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 Pm will bo processed the next business (lay. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INn*IjhLS _ <br /> REVIEWED_ YES _ NO REVIEW DATE '� <br />