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08/15/2005 16:09 8189790"� <br /> JMK ENVIRONMENTPQ PAGE 01 <br /> A1!i � f-� Em wcHwabSR� U EEL SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q,I <br /> Irl ? 2005 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ST 2KrON .3420 A95202 135 <br /> ENVIRONMENT HEATH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ^far 4 (4�d�6i 13USINESSIAGFNCY <br /> APPLICANT /^� /�� / c f� �( <br /> ADDRESS X14 b /U. ,•w. !A' JQSI LE 1 ' -7q 0V <br /> PHONE 0 I� `�` � � —FACSIMILE O <br /> TIME 2- -v) .P0► <br /> TENTATIVE*APPOINTMENT DATE <br /> lication submittal) <br /> (Please D <br /> lve T to 10 businsss days from date of app <br /> CHECK BOX TO EXPEDITE REQUEST• FE -REQUEST P OCESSED IN 3 BUSINESS DAYS <br /> DATE �I <br /> SIGNATURE OF APPLICANT <br /> THIS <br /> GDSE ONLY <br /> PRORAM ELEMENTSUSEARON <br /> nLC ADDREEE Q <br /> us 1 <br /> Vill <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> D HOUSING A9ATEMENT O SOLID WASTE F ILITY <br /> >ZC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) p HOOD FACILITY p SOLID WASTE VEHICLE <br /> j!I OTHER CLEANUP SNE(NONITORI p DOG KENNEL p DAIRY <br /> O CHICKEN RANCH 0 PUM ER TRUEteT PLANT <br /> }A'' NDERGROUND TANK(MONRORINGIREMOVAL) p PUMPER TRUCKIYARafCHEM TOILETS <br /> 9K HAZARDOUS WASTE GENERATOR p MOTEUHOTEL <br /> p TIERED PERMITTED FACILITY p POOUSPA O LAND USE APPLICATION SITES <br /> • TATTOOMODY PEIRCING o OTHER(DLPASE SPECIFY) -' <br /> D MEDICAL WASTE PACILrTY <br /> List Up to ten addresses in the space above. Seiect the type(sj of files from the list above ny checking <br /> t tog 4 e11138 or mail to_th® <br /> tho appropriate beex(ps)- At least one filo type MUST ba selected. �"'- <br /> addressi dicated ave. <br /> EHD will notify the applicant If any EHD files exist. An appointment for review will be conon. Thefirmed <br /> LA <br /> w I be held for avmaximum of five businesas days forereview�ApPoiIrtITIe is should be acheduledfiies <br /> 2, <br /> accordingly, <br /> r review. Anew <br /> g A file that Is actNoly beinD worked on by EHD staff maY not be Immodiately avallabl®to <br /> application may be Submitted when the file is available. at the expenSO <br /> 4, Any File not returned in th¢same condkian as released will be roorganlzed by EHD deposit prior to review. <br /> - of the applicant Future fila reviews by the same applicant maV require a$89,00 dep <br /> e it HD a <br /> 6 *TENTATIVE appointment dates mu Wb b processed the next b sines$day. <br /> 6, Applications received after 3:00 p <br /> TIME <br /> CONFIRMED.APPOINTMENT DATE INI IAL$ <br /> DATE CONFIRMED PHONE FAX <br /> REVIEVVDATR <br /> REVIEWED <br /> Y£5 No .. <br /> Bio 4eA3-0Oe <br /> 71]ea�9 <br />