Laserfiche WebLink
Mar 31 2003 5:33PM CO6R EARTH TECHNOLOGIES 4 10:;:279 P . 1/1 <br /> cnx • zm LOG NUMER <br /> �ja f=d'117 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SER1/10ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AFR 0 1 '2003 304EAST WEBER AVENUE, 202 FLOOR <br /> STOCK70N CA 95202 / <br /> tNVIR„lviJLM HEALTH . (209) 468-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICAN7T: 4 �$O %%41�BUSINESSJAGENCCY� <br /> ADDRESS '�+� S� cir,G•a�1 <br /> PHONEic1.�. -� FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 hus4vts days ttOm date of application sub riftal) , <br /> 4 <br /> 95 <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS GAYS L j, 1 <br /> SIGNATURE OF APPLICANT a DATE-= 1 J D3_ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY n� <br /> PROGRAM ELEMEtrTS SEARCH <br /> o(dr� oe. I _. <br /> i0/3 5. io/l 't 3 <br /> I _ <br /> ELI <br /> X60 >r• �, .r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT � LI <br /> SOO WASTE FA&t'tKI <br /> OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY � SOLID WASTE VEHIPYk <br /> fx UNDERGROUND TANK(MONITORINGJREMOVAL) ❑ DOG KENNEL ❑ AIRY <br /> HAZAnDOUs wASTE GENERATOR ❑ CWCKEN RANCHWG TREATMENT PLANT <br /> Pr TIERED PFjwnTEO FACILITY C) MOTaMOTEL ❑ PUMPl°RTRUCHJI'ARD/CHEMTOIL.ElS <br /> ❑ TATTOO/BODYPEIRCING ❑ POOUSPA ” • 12 LAND USE APFLX:ATION Sn`CS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 0711E+7t PLEAS Ft SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above.. Select the type(s) of flies from the IN t above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax tD :20. 9) 4GzL4138 or MRil� 1 tt(e <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The 5's <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is aetively being worked an by EHO staff may not be immediately available for review. Anew <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 expense <br /> of the applicant. Future file reviews by the same applicant may require rI W.00 deposit prior to ntview. <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 TIME <br /> � Y-1-03: (eF-J-n-iessacf-� foe irni� 2a cGrz°.�s g; o$a✓� <br /> nATP(1r)MCIDI1 rn cAv .+..+++. •• <br /> (C �, S LIC) M, (3 <br />