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MAR.10.2005 10:59AM W�ENVIROTECH.mc. NO.289 P.1 � <br /> EMD LOCH NUMBER _ <br /> DATE RECEIVED <br /> ( SAN JOAQUIN OUNTY <br /> RE'g�vguu ENVIRONMENTAL HEAL H DEPARTMENT � <br /> 304 East Weber Avenue,3rd Floor, toakton, CA 95202-2708 ' <br /> Telephone!(2Q9)46$-3424 Fax:(2119)4 -Oi3$Web: www.sjgov.Orglehd . <br /> .-MANX 0 2D05 ' <br /> ENVIRONMENT VjE LPA PUBLIC RECORDS RELEASE APPLICATION <br /> T:�tnylWt0.� BUSINESSIAGENCY: <br /> ADDRESS- � U�� �. r `t 73'�� 1 <br /> PHONE(1). 4;:VqG-L- - PHONE(2): thl C-L(18 -'a%0 42 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: da` >,y Time: 4 <br /> (Please allow 10 business days tram date of applications bmlttal-•Tentativ'e only.must be confirmed) <br /> ❑ CHECK SOX TO EXPEDOE REQUEST,S93.Oo r-EE(C�A.SAH OR CH CMC ONLY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT v v�` CAS to <br /> $r- <br /> UNIT <br /> rUNIT DISTRIBUTION G Unit 1 0 Unit 2 ❑Unn 3- Unit 4 Unit 5 CG unMt 5 C other(elactronle4listelmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Sttrret# Streat Name City <br /> 3. 47.0 sv'-IC :"? 'P � cJ <br /> q t1" 5-A <br /> 5. <br /> J <br /> ..L:. <br /> rwi- <br /> -IS 5--1 60 <br /> Specirio Data Range of Information Requastad:From �' t to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Hous1"GAsATFv 13 sopowmm rac LnYNF+lCL9 <br /> �UNOERGRgUHa TANK{UST)C1�AII�517E(LOP) 0 FOOD FAGUTY 10 WASTE TIRE <br /> El OTHER CL NUP SITE(NON-LOP) <br /> I3 UNDOMROUNDTANK(MONRoRiNsftmovAL) d Coo K1=NN£L Y <br /> ' 0 DAIRY <br /> wARYiATER iREATMENTPLANT <br /> 0 HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH <br /> 0 MoTEU14OTE4 ❑PUMPrATRUWYARAICHEMITOILETs <br /> Q TT-rb PERMIT{EP FACILITY C LAND UuR ApPuCAnoN PTEs <br /> IM TATT40IS�Y PIERCING C1 POOLISpA <br /> C3 MEOICALwASTEFACIUTY 0 OTHER(PLEASE$3F=CIC <br /> WELL ANP Sr-FmePERMIT REWRp6ARE AVAILABLE FORREMEIH- N ONOAY-FAIDAY9,80AM-S:oOPM - EXCWo1NOHOWDAY9. <br /> 1, List up to ten addresses in the space above, Select the type(q)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be sele ed. Fax to 209 464.0138 or mail to the address <br /> indicated above. Address ranges will not be accepted— or additions!assistance with Elle addresses,contact <br /> the EHD.Applications received after 3.00 pm will be prrac ssed the next business day. <br /> 2. The EHD will notify the applicant if any 1rHD files exist. A appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be hold for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHo staff may n t be immediately available for review. A new <br /> application may be submitted when the file is available, <br /> 4. Any file not returned in the same condition as released wi il be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 1 nacos <br /> i <br />