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11/02/2004 10:04 9168610SECOR PAGE 02/0 <br /> 07./2004 15:10 46401-.-- ENVIRONMENTAL W. "TH PAGE 01 <br /> 4- <br /> DATE Ft QFIV MD y tM LOG NUMBER <br /> o �, ,1`:•,' AST-JOAQU N CCOLUM, ` <br /> 304 E Weber Ave 3`4 Floor Stocktou,CA 95205 <br /> NOV 0 2 201409)469-3420 ax- (209)464-0136 Web:www.co.sao joaquin.ca.t�s/ehd <br /> ENVIRONW-W HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APi'LiCJWT: D h L�tIS[NESSrACEliCYo i h��►rt'J�[Sfi <br /> ADDRESS: Son , 1PIdr.Q d <br /> PHONE. ('7/U) 8t41-dy no FACSIMILE: (0)10 �ce <br /> TENTAYlVE'APPOW NENT DATE'-11--5 0,C/ <br /> U UOQ�►.. <br /> ln <br /> (Ploy 01(ow 10 busimbos days from state of appliwtson somiit K. <br /> }.r <br /> a y <br /> Pf CHECK BOX TO ExPEDrM REQ1rEST-393.00 FEE-REQUEST PROCESSED IN 3 BUSINM DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> R�osr6rrent Uss t7r�ilr <br /> FILE AMMSS f <br /> f9e,": <br /> z s ZZ 1'DCPti �+ t! _ S � ✓tie ao`!�?o/ <br /> I <br /> A <br /> P � 2 <br /> 4 f / " Unit 3 <br /> ;s. ` -4,0_ lL Shu �r�n C A iz / <br /> r. saeHO b 5 �7 Unrt 4 <br /> ` : cam,. s. Soeel .SO) L i Piro" <br /> 44: Ssw �Q L1yf(' ✓� 5 <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> 0 UNDERGRGUND TANK(UST}CLFMUP SITE(1,0P) Q "OUSIM ABATEMENT 0 SOt_ID WASTE FACILMY ih <br /> d OrrMR CLEANUP stTE("ON-LOP) Ci FOOD FACLnY o sot.m WASTE VEHICLE <br /> la;uNDeRr.RmNDTANK'(M0N" xl1`IGIRemcrvAL) 0 OW KENNEL Cl DAIRT <br /> CHICKEN l�AlICH 0 PICC TREATMENT PLANT <br /> • TIER RD ERMn-TUS WASTEFAM1RAT4Ft M PUMtP9R TRUCWAR0(CH1FM TGlt M <br /> L3 TIERED PE�LMrrsEb FAdLC37 Q MOTt:LffiQ"rE� <br /> O TATro-WB60Y PIERCING In POCUSPA Ar LAND USE APPLICATION SMS <br /> 13 MEDIWLL WASTE FACILITY d G1TH>"R jp),EASE SPEpiFY) <br /> i, List up to t@n addresses In the space above. SQ#ACt the types)of tiles from the Test abaire by cher-king <br /> the appropriate bax(es). At least one file"MUST be selected. Fax to 209 464-0133 Rr m9Bqjh1 <br /> address) ab e <br /> 2. FAD will notify the appllaant if any EHD files exist An appointment for review will be confirmed <br /> approximately fire business days but no later than ten(10)clays ager receipt of application_ The files <br /> Will be held for a maximum of five business days for review. Appolntments should be scheduled <br /> accordingly. <br /> 3. A file that is aOjveiy being worked on by EH <br /> staff may net be immediately avallaiale for reviey+r. A n¢w <br /> 91pplication may 1g Submitted When the file is available. <br /> 4. Any filo not returned in the salve condition as released will be reorganized by EiHD stall at the exp*nse <br /> tilt the applicant. Future file reviews by the tame applicant may require a;93,00 deposit Qrlarta resew <br /> �. *'TENTA'l NE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day- <br /> lT'I)A*Er" y TIME :r� '., ,._ ;x <br /> r <br /> :CJA'fE t`i0I1�l4�MEif ''.. .,. . _ - •..-.. 'r1 HONE <br /> DATE. <br /> hIIEW>~f3 <br /> YES NO REVIEW <br /> /J// wn MM1 <br /> �Y <br />