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,a03 07:43 7146711008 ESS 1`34 GE 02 <br /> 2005 .IQ �I4 . 4E4813 tiY lrurvr,ruvi n� rr�� nrwnw +Datil'l [[il SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY 0 1 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STpCK'fON CA 95202 <br /> Vv 5 <br /> cPlA/IRtil`.i!11Eiul HLAIIH (209)AGGra420 <br /> - „_.. �€��r RUSINESSIA6CN <br /> PUIBL IC F2ECCIRCI$ RELEASE APPLICA,TI ON <br /> APPLICANT. S ta—L l -'�`i/'d eY�')t/1 /0'7 ._5 U iq I f T `ev r f- <br /> ADORESB a'700 Cr of (1 Cf-/' 11tY 4-v Pi. C,A <br /> PHONE ��H !!L / /G FACSIMILE 7/11 �'' <br /> TENTATIVE*APPOINtMENTDATE TWE <br /> (Please piva 7 to 10 buslr.we 4OP fiwn data of Sppn6N1041 sWnarod) <br /> CHECK BOX TO 9XPFDrrE REQUEST-W9.0 FEE-RE EST PROCESSED INS OUSINZIi3S Rhyl. ' + 51q <br /> -(SIGNATURE OF APPLICANT ._._, DA3E <br /> FILE ADDRESS -TI�) S CII I"MTTTT'�7UJIE ONLY <br /> PliOGRI M ELEMENT'S IIRARCH <br /> Ll <br /> ,J/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> `p UND[RDROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMIINT ❑ eOLID wAI TS PM:ILRY <br /> OTHax CL[ANUP SITE(NON-LOP) ❑ FOOD PACILnY ❑ 6OLKt WAt:dTi VEHICLE <br /> uN0940ROMD TANK(MONrTORINGREMOVAL) D DOG KENNEL Cl D/DRY <br /> HAXAROOUS WASTE OENERATOR M CH)CKGN RANCH ❑ Pr;r.TR[A'fMI1HT PLANT <br /> TIERED PERMITTED FACILITY 0 VOTELIH43TRL Cl P MPTIR T[UCKrYARD(CN1[tr1 TOILETS <br /> O TATTOOrBODYPEIRCING O POOLR'.PA ❑ UNG VSIL APPLICATION SITIN <br /> ❑ MEDICAL WAST[FACILITY in OTHER(PLEASE SPECIFY)_— <br /> 1. List up to tell addressee In the space above, Select the type(s)of flies from thn lllst.above by Checking <br /> the appropriate box(es). At least one Hire type MUST be selected. EMjIL.I122.1±ktQ:LR or mr II Jta <br /> addroindicated above <br /> 2- EHD will notify the applicant If any EHD file&exist. An appointment for ro4levr will brr confirmed <br /> approximately five business days but no IAtfr than ten (10)days alta'NPOnlpt of application. The filen <br /> will be held for a maximum of five business days for review. Appointmr ribs er,ould I"scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immedllttady a"iieblu for review. A now <br /> app kation may be submitted when the His h1 available. <br /> 4. Any file not returned In the Same Condition as released will be reorganized by CHU staff at the exPenlal <br /> of the applicant. Future file reviews by the same applicant may regUire a$84.110 deposit prior to MViWW. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next buninas2 day. <br /> CONFIRMED APPOINTMENT DATE _ TIM! ---- <br /> DATE CONFIRMED PHONE FAX INPiOAL�1 — � <br /> REVIEWED YfES NO ^ REVIEW DATE <br /> ,vz►aeol <br />