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09/16/2003 15:53 9253715.915 GEOCON - EAST BAY PAGE 01/1 <br /> ENVIRONMENT'f�EALTH PAGE 02 <br /> DATE RBCEtVED � - r-n„�.....,,_•.._, <br /> o � �,(��Jif=� ,. <br /> SAN JOAQUIN COUNTY <br /> C I f C Er]VItRONMENTAL UEALT'H DEPART'MEN'T' <br /> 304-E Weber Ave Tl Floor Sto&to;II, CA 95205 <br /> S E P 1 6 2001209)468-3420 Fax: (209)464-01.38 Web:www.Co.sas>,joaquin.ca.us/ehd qq3 <br /> ENV1R0rNVM0EUT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Pt t �+ <br /> APPLICANT: C( CG ausiNEswA6ENCY: C� OI C.O <br /> ADDREW: 3 <br /> PHONE: Z .S=3 7( d° �AcslMl�eQ:_ � �S= 3 7�- <br /> TENTATIVE*APPOINTMENT DATE: TEme: <br /> (Please allow 10 buelneaa days from date of applioation submittal) <br /> GHECK BOX TO EXPEDITE REQUEST-$93,00 FFEe REQU PROCESS D B NESS DAYS <br /> SiGNATURE OF APPLICANT DATE <br /> Dapartrnant Use Only <br /> FILE ADDRESS UNIT <br /> Unit 1 <br /> C �) <br /> tr 4 o 35,2 <br /> d s siO D d c <br /> city vin <br /> it 3 <br /> t. Z v lML 1,tW <br /> a i 4/eq ec a Unit 4 ' <br /> z a <br /> 1 Ar ❑ Unit 5 <br /> to. st <br /> ENViRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGPOUND TANK(U»1)CLEANUP SITE(LOP) 0 HOUSING ASATEii ANT E3 SOLID WASTE FACILnY <br /> 0 OTHER CLEANUP SIM(NON-LOP) 1 0 ROOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C3 UNDERGROUND TANK(MONITORINGIRi;MOVAL.) Cl DDG KENNEL d DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMeNIT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTIRLIHOTE3L O PUMPER TRUCKiYARD/CHiEM TOILETS <br /> 0 TATTOO/130V i jFRCINrt CO POOL/8PA 0 LAND USE APPLICATION SITE-6 <br /> O MEDICAL WASTE FACILITY D OTHER(PLX43M SPECIFY) <br /> 1. List up to ten addresses in the space above, Select the type(s)of files from the flat above by chetking. <br /> the appropriate box(es). At least one file type MUST be selected: t=ax to(a09j440A-0 38 or MR:0 to t((e <br /> attgrgle;indicated ahoy <br /> 2. EHO will notify the appiioarlt if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bueinoss days but no later then ten(10)days after receipt of application. The flies <br /> will be held for a maximum of five business days for review, Appointments should be scheduled <br /> aGCordingly. . <br /> 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new <br /> application may be submitted when the Fite is available. <br /> 4. Any file not returned In the some condition as released will.be reorganized by EMD staff at the expense i <br /> of the applicant. Future file reviews by the same applicant may require a$43.00 daposit prior to review. <br /> 3. *TENTATIVE.appointment dates must be confirmad with EHO staff. <br /> 6. Appllcatlon6 received after.3!00,pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT GATE TiME <br /> DATE CONFIRMED PHONE . FAX iNMALS <br /> RIE%AEWED YES NO REVIEW DATE; <br /> • a�er�vaa . <br />