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0 /02/2004 12:09 FAX 209 '0621 Z 002/002 <br /> DATE RECEIVED , cn— .., ..., <br /> (�IIl`v\\II — SAN JOA UIN COUNn <br /> N ��ISuEN-aRorrnmNTALAEALTilDFPARTn ENT <br /> 304 E Weber Ave 3'd Floor Stocktoi4 CA 95205 <br /> MAR 0 2 2004(2 09)468-3420 Fax: (209) 464-0138 Web:www.co sazl joaq=' .ca us/ehd <br /> ENVIRUNiIMENI- HL '(H PUBLIC RECORDS RELEASE APPLICATION <br /> p6W4a4EW/ULE 11 <br /> APPtrANT: BUSINESSIAGENCY: l �► 1 F`{GL) 12 <br /> a,DOlss �Z� M`( S�c.C_.� <br /> PHONE:- � FACSIMILE: A <br /> qS7- D b'L-1 <br /> I� - <br /> TENTAME"APPOINTMENT DATE: 3!I I 0 y Time: 1200 <br /> I (Please allow 10 business <br /> days from date of application submittal) <br /> CHECK 13OX TO EXPEDITE REQUEST-$93.00 FEE-,REQUEST PR SED IN 3 BUSINESS DAYS <br /> 1. <br /> SIGNATURE OF APPUCANT DATE 3l21 D <br /> Numrtrr u Use O&Y <br /> FILE ADDRESS UNn' <br /> Unit 1 <br /> z. Wee, v Gil <br /> 1. suza Iq 3 cay Loy U� <br /> n 2 Unit 2 <br /> 4. Strrel <br /> s. s61t,4 9- CK-1 P Unit 3 ( �� <br /> 6. soca 1n► W IV� <br /> j. 31 r L o S~, U ' 4 <br /> e. st"e L _ I-T' .24 /ht 4Gd <br /> 9. 54ee1 I <br /> city <br /> 14. SECN <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUYD TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 1M SOLID WASTE FACILF Y <br /> SC OTHER CLEANUP SFTE(NON4-OP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> $ UNDERGROUND TANK(MONFTORING/REMOVAL) ❑ DOG KENNEL :@U DAIRY <br /> ®'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 45 PKG TREATMENT PLANT <br /> ❑ TIERED PERM TTED FACILITY ❑ MOTELMOTEI_ ❑ PUMPER TROCKNARO CHEM TOILETS <br /> ❑ TATTOOMOC)i PIERCING Q POOUSPA $ LAND USE APPLICATION SrMS <br /> ❑ MEDICAL WASTE FACILITY El OTHER(PLEASE 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 rile type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above- <br /> 2- EHD Will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> appSoxlmately five business 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 new <br /> application may be submitted when the file is available. <br /> 4. AnYjfile not retumed In the same condition as released will be reorganized by EHD staff at the expense <br /> of tie applicant. Future file reviews by the same applicant may require a$93,00 deposit prior to review <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> a"bNFl,R ED."APPQ(PCTMENYUATE).'::.- :r : TIME <br /> :-DATE-00N1✓RMED ;!PHONE FAX' 'ANITIALv� <br /> .R1 VIEVVED i YES NO REVIEW DATE. <br /> ENO��-0i-0QB h 1 , <br /> ararzoo] l - <br />