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09/16/2003 15: 53 925371Fa15 GEOCON - EAST PAY PAGE 01/1 <br /> . ' ENVIRONMENTOFALTH G <br /> DATE RECENED cn� PAGE_ 02 <br /> X0221 Si�11/II'. F <br /> SAN J�OAQUIN COUNTY <br /> LC ll�[c' <br /> ENVIRONMENTAL WALTH DEPARTMENT <br /> 304 E Weber Ave 34 Floor Stoektolt, CA 95205 <br /> S E P 1 6 2001209)468-3420 Fax: (209)464-0138 Web:www.co.sau joaquin.ca.us/ehd I <br /> ENVIRONMENT HEALTh PUBLIC RECORDS RELEASE APPLICATION <br /> ° /bl:NVK 7- <br /> APPLICANT: C4 - BUSINESS/AGEFNCY: <br /> ADDRESS: <br /> PHONE: I Z .S`.J 7( �9d0 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (please allow in business days from date or appllQatlon submlttaQ <br /> CHECK BOX TO EXPEDITE REQUEST-$93.116 PEE-REQU PRGCESS'O 0 NESS DAYS <br /> SIGNATUREOF APPLICANT DATE <br /> Departthant Use Only <br /> FILE ADDRESS UNI <br /> 313,7 C [;Y Unit 1 <br /> G <br /> Ir6 0 L lr� Unnl[2 - <br /> i s O D de CRY <br /> G V 3 <br /> 2 o J <br /> i <br /> It I Q0 t rIR 4 <br /> l F i [] Unit 5 <br /> o. atOty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILnY <br /> ❑ OTHER CLEANUP SITZ(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINCIREMOVAL) U DOG KENNEL In DAIRY <br /> I7 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH - O PKG TREATMENT PLANT <br /> Cl TIERED PERMITTED rACILrrY Q MOTALIHOTBL 0 PUMPER TRUCKIYARDICHEMTOUTS <br /> Cl TATTOOIBODY PIERCING ❑ POOL/SPA - O LANE)USE APPLICATION 31"S <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLRMR SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking. <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209141%418 or mail to the <br /> address indicated altoyeindicated atzoye. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five butiness days but no later than ten(10) days after receipt of application, The files <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 actively being worked on by EHD staff may not be immediately available for review. A now <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 EMD staff at the expense <br /> of the applicant. future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates trust be confirmed with EHD staff, <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE ' TIME <br /> PATE CONFIRMED PHQNF . FAX INffIAL5 <br /> REVIEWED YES NO REVIEW PATE: <br /> e/Gmas <br />