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4 1 <br /> PHONE NO. : 916 985 ©786 Aug. 20 2004 08:40PI9 P1 <br /> FROM S I ERRR WEST-BRIGGS+LANDES p JV IRO �IEhfrAL HcF��TH PAGE 01 <br /> cnv�vv•.v•••'�'` <br /> 03/20l2a04 :a:53 460138 <br /> RATERE��NEP SAN JOAQUIN COUNTY <br /> Lf��,�IJ IE Irl -Er,VHt0N-�rITAL HEALTH DEPARTMENT <br /> 3p4-e Weber Ave 37d Floor Sto6ton4 CA 95205 <br /> AUG 2 3 )4�8-3420 F": (209)464.0138 Web:v,.%,W,C0.San-joaqujn.ca.us/ebd <br /> Iq <br /> ENVIRONMENT HEALTH kUBLIC gXCORDS RELEASE APPLICATION <br /> PIT' <br /> APPLICANT; L�NP � BUSINESS/AUNGYI <br /> AoDfEss; CoZ°1C.Ovp2� -�18�o P4 pI 3� <br /> �O ~ (> FACI(MILE• l� /� C <br /> �k Time., <br /> TENTATIVE*AppoINTMErtT OATS: <br /> (ploaee Allow 10 busine.9 days fron date of 001-00n submittaq <br /> To EXPEDITE <br /> ECGESS&b III BUSINESS DAYS <br /> CF► 7C 8000 Fca4UE3YE£—-S9S �� SaA'CE <br /> SipNATURE Of APPLICANT Department use Croy <br /> UNIT <br /> FILE ADDRESS <br /> > �� [� Uni4 i <br /> Sr / <br /> p , `? _ r`dZour_ Oc <br /> "7Cl - ST [� Unite <br /> I yr Unit 3 <br /> a. Unit4 <br /> Wl i1��t -�� Fn✓, `f D p unit 5 <br /> e. a <br /> a ` <br /> � ; <br /> �N�f{pTituIENTAt.HF-ALT'"DEPgftl'MENT Fa <br /> grM(Lop) 0 HOUSING ASA7"ENT ❑ EOUp WASTE F: <br /> UNOERGROUND TANK(UST)ctsaNu� ❑ SoUt)DAI WASTE tJEtltcts <br /> 0 FOOD FACtI.-trr Q DaSRY <br /> �QTFiER.{LEmup SITE(NON-LOP) DOG KENNEL ❑ PKG TREATMt"NT PLANT <br /> UNDERGROUND TANK(M0NITORIN(31Rr-MC;VAL) p C11ICKEN RANCH ❑ PUMPER VWCKPlAKDM1`IFM TOILETS <br /> C HA7 DOUS WASTE QENERATOR m m=LmOTEL O LAM USE APPi_ICATIom SITES <br /> Q TIERED FEWM0 PACIL[Ty 0 POOLISPA <br /> d TAT7c3alSODY PIERCING p MFR(pt.F.AeE SPECt" <br /> MESCAL WAS FACILMY <br /> type(s) <br /> g pt{)ip$from the Itst aboye by checking <br /> 1, List VP to ten addresses in the space above. Sslect the <br /> selected <br /> ( ) t 00914 o mall to <br /> ms At least one filo tyPA MUST Selected. <br /> the appropriate bax( )- <br /> e st in"Ont for review will be confirmed <br /> EHl7 will aM2notifthe applicant if any EIiD tilAs exist Art epee after receipt or application. The f ilea <br /> approxirnately five business dflys but DO later than t>trl (10)d Intmants should be achpduled <br /> will b*held for a maximum of fl business days for r*viow. AppO <br /> raccordln0ly. � worker on by EfID> may not be immedlacQly�vailabiQ for review. Anew <br /> 3. A file that is act}v ly being a�nlzad try FHD staff at the expanse <br /> pppiloatlon may bo submitted when the Finis mlpa ed osit Qnar to review. <br /> 4. Any file not returned In the a8m9 condii)an&M 1 aascd�It may Cequlre a$93.00 dee <br /> of the aPPliGant a tmentle reylOWS dates must be conflrmed w9th EfiC std. <br /> 5 -TENTATIVE aAP m will be processed the naxt busimess day. :« <br /> 6. Applications received after 3:30 p <br /> 1�- 57; <br /> TIME <br /> CONFIRMED APP OINTMeW OATS p(iDNE~ FAX IN1T1A1S _�---�— <br /> DATE CONFIRMED � . �.�..----� REVIEW DATE <br /> I��tIEWEt3 <br /> YFS NO <br />