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SECOR PAGE 01/1 <br /> 1004 16:03 9168610430 PAGE U2 <br /> FIFTH FLOOR <br /> (��� � 209466* --. <br /> `Vl I •IVB SAN JaAQUiN COUNTY <br /> I _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2004 304 EAST WEBER AVENUE,THIRD FLOORZ11+3 <br /> NOV 19 5TOCKTONCA95202 <br /> H <br /> (209)458.3420 <br /> -NVIRONMENRCES H PUBLICRECORDS RELEASE APPLICATION <br /> S , <br /> fj <br /> APPLICANT 7gbb t .1.'T�r` 9USINESWASENCY .1''rOle <br /> ADDRESS �C• <br /> n :IAV I� ,_. Ia n7uv�Q ')i D tic Dnl O✓Gila 7 � /StlyL lJ' , <br /> PHONE 91b' <br /> TENTATIVE-APPOINTMENT DATE_ d� _ ME <br /> (Plemn give 7 to tQ bvsi ss day.Tram date of application submi� �� •, r^ 1 T`"'* <br /> ❑ CNECK13OXTOEXYhDRE(R>FQI T. \.DOFEE RELlUES7PROCESSED IN3BUSINESS DAYS d '/ <br /> SIGNATURE OF APPLICANT —— DATE <br /> THIS SIDE 0 STAFF USA ONLY <br /> FILO AUDRESS FROG LEMrNTS SEARCH <br /> �i✓er, 402e"at75±�_.8s3 •.yosc 4C rtlan41: <br /> low � -- <br /> l=NVIRONMENTAL HEALTH DIVISION FILES <br /> V UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID TE FACILITY <br /> Q OTHER CLEANUP Srl'E(NON-LOP) ❑ FOOD FACILrfY r_1DAIRD W TE VffHICL1; <br /> UO UNDERGROUND TANK(MONITORINGfREMOVALI O DOG KENNEL t7 DAIRY <br /> ❑ HA7ARDOUS WASTE GENERATOP. n CHICKEN RANCH [7 PKG TREATMENT PLANT <br /> 17 TIERED PEFMI I IED FACILITY ❑ MOTBLIHOWL O PUMPER TRUCKNARDfGHEM TOILETS <br /> ❑ TATTOOBODY PEIRCWG ❑ PQOVSPA ❑ LAND USE APPLICATION SITES <br /> d MEDICAL WASTE FAC)1.rrY O OTHER(PLEA9F SPECIFY) <br /> T. List Up to ten addresses in the Spaco above. Select the type(S)or tiles from the list above by Checking <br /> the Rppropriate box(es). At least one file type MUST be selected. Fa to J;L09 4 -0_73 o ail to the. <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD files exkt. An appointment for review will be confirmed <br /> approximately fivr.business days but no later than ten(10)days atter receipt of application. The Tiles <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 31 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. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the Pxpense <br /> of the applicant. Future file reviews by the same applicant may require a$$9.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3;D0 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE .......�_�._ TIME —. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO _ REVIEW DATE <br /> EHa 2241 <br /> Y2&2005 <br />