Laserfiche WebLink
nyruir1e�4 .;:1z:4r 2a9-579=2225 MODESTO ATC PAGE, . F�1. <br /> DATE RECEIVED F-HO LOG NUMBE <br /> SAN JOAQUIN CbuNr ' r <br /> E DD <br /> EIR4NIVMNTAL MALTA DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stacktoaa,CA 95205 <br /> S E P 0 1 2004 (209)468-3420 Fax.-'(209)464-0138 Web:www.co.san-joaquinca-us/ehd <br /> LAVIR,, VMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 0 f,e,w u a%N Mt--, BUSINESSIAGENCY:: AT " <br /> ADDRESS: <br /> PHONE: S71A ~ 7-7-'Lt FACSIMIL . 1" 5- T-7 - 7-1---y- <br /> TENTATIVE*APPOfNTMENT DATE,. Cl Tim*:.-.. Q 7 CIO <br /> (Pians*allow 14 business days from date of appitcatlon submittaf) <br /> El CHECK SOX TO EXPEDITE REQUEST•583.00 FEE,-[REQUEST PROCESSED IN 3 BUSIHESs DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> N� 0in,.1 Lit �,las 'I' S► S "(4+�+ro-k9�� O" ItJiSf(QC2,{�fi Department Use Only <br /> F&V ADDRESS I UNn' <br /> a,t i Lv t-A%rt- CW ! AZ !�Y ❑ <br /> z 5 t S-1 t-A--rL q g s 1C i- Unit 1 <br /> S 5.)� �. s�� c� � << *�w-� y S V. �� 5 ❑ Unit 2 1-Io-O <br /> 40-I <br /> a. stru G.o L k. J��q.r� Std $ Gk, 3 <br /> 3 Sa 7 U a. 9lr�et Z � l; rl.,��L► [4 a lKra At tti <br /> C�V% t�. ON S 4�o erlC�a� :!tUn' <br /> d� a+�t S t k. <br /> .� L •5tr S ! ❑ Unit 5 <br /> I <br /> RONMEMTAI-HEALTKDEP_ANtMENT F LES- <br /> UNDERGROUND <br /> ES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> tib OTHER CLEANUP SITE(NON-LOP) O FOOD FACWTY ' C3 SOLID WASTE VEHICLE <br /> IIsi' UNDER13ROUNO TANK(MONITORINGIREMOVAL) 13 DOG KENNEL C7 DAIRY <br /> W HAZARDOUS WASTE GENERATOR © CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> li TIERED PERMITTED FACILITY I7 MOTELMOTEL t3 PUMPER T''RUCICIYARDICHEM MLETS <br /> TATTOO/BODY PIERCING d POOL/SPA I 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE i PECIFY}_,,, <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(as). At least one file type MUST be selected. FM t 8 or mall t <br /> address Indicated so_v_9_; <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tea (10) days after receipt of application. The files <br /> will be held for a maximum of live business days for;revlew. 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 ns-. <br /> application may be submitted when the file is avallal`le- <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 app'liCant may require a$93.00 deposit prior to reviev <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3:00 pm*111 be processed the next business day. <br /> CONFIRME13 APPOINTMENT DATE I TIME <br /> DATE CONFi>TmEo. — PHONE FAX `1N6 AI,S:: <br /> REVIEWED YES NO REVIEW DATE <br /> Enna* <br /> j <br />