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Z002 <br /> 08i16i2004 Ly%i9o�l- 209 9480621 ao(aI✓!a, dy <br /> ��1I MAN <br /> Erio roc rluuaFx <br /> oATE h�1—,ll� L��y <br /> nIC,U AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH 'DIVISION <br /> AUG 16 2004 304 EAST vvE1 57 <br /> OCKTON CA 95202 D FLOOR <br /> ENVIRUMvIENT HEALTH (209)468-3420 <br /> PERf,AITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> �rarJ Bear lNJrde �Qt/' <br /> BUSINESSIAGENCY lei <br /> APPLICANTItiI fly Sf IS'��c <br /> ga s g_ <br /> PHONE <br /> IF_ 3y _FACSIMILE <br /> PHONES �^ <br /> 's W 0 TIME <br /> TENTATIVE'APPOINTMENT DATE <br /> (Please give 7.-.. <br /> business days om date 0I aPPflcatlon sobmltta <br /> 91,00 <br /> CHECKBOXTOEXPEOITE REQUEST- -e EE-RP4UEST PROCESSED IN3BUSINESS DAYS <br /> DATE 77 <br /> SIGNATURE OF APPLICANTTHIS SIDE EH STAFF USE 3� ( <br /> pROGRANI ELEMENTS SEARCH <br /> Y <br /> FILE ADDRESS <br /> IoI17 S Q 1f! OC l /(/ <br /> 41 fMP ✓ ,v <br /> bac n/ MC <br /> LNar e e,vue toA/ p <br /> 1 ,trove <br /> ✓.. ac i 2 <br /> 07 M40 J <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> SOLID WASTE FACILITY <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) 0 FOUS FG AL'- 'rLMEM ' SOLID WASTE VEHICtF <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL DAIRY <br /> f7I UNDERGROUND TANK(MONrt'ORTNGIREMOVAL) ❑ CHICKEN RANCH PKG�� P CHEM TOILETS. <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEt1HOTEL ... y❑{PUMPER TRUCK/YAR o <br /> TIERED PERMnTED FACILITY ❑.tAoTrVPA -"' PLA ND USEAPPLICATION SRP-. <br /> ❑ TATTOOIBOOY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY q>jOVE! <br /> ❑ MEDICAL WASTE FACILITY <br /> List up to ten addresses In the space above. Select the types) of files from the list above by checking <br /> 1• a MUST be selected• ax to 209 64 0138 or mail to the <br /> the appropriate box(es). At least one file type <br /> address indicated above. . eipt of application.confirmed, <br /> The files <br /> 2 EHD will notify the applicant if any EHD files exist An appointment for review will be confirms <br /> approximately five business days but no later than <br /> an ten(10) days should scheduled <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3• A file that Is actively being worked on by EHD staff.may not be immediately available for review. Anew <br /> application may be submitted when the file is available. ,reorganized by ense <br /> 4 oAny f helappl cant. Fudtu a file reviews bycondition <br /> the same applicant may require a S8T.00Hdeposit prior t expense <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff' <br /> 6 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> T[I <br /> DATE CONFIRMED <br /> PHONE FAX INIITALS -� <br /> oc1tlFN/neTF <br />