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09/16/2003 15:53 925371 5 GEOCON - EAST T PAGE 01/1 <br /> ENV IRONMENTAt"WEALTH <br /> PAGE 02 <br /> DATE RECEIVED cn�. <br /> r� c'r((� �, ,.. SAN JOA.QUIN COUNTY <br /> I�._�; E1vvzRorrmrriTAx,7At,'Z DTPAItTMENF <br /> 304-E Weber Ave 3'1 Floor Stot toji, CA 95205 <br /> SEP 1 6 200209)468-3420 Fax. (209)464-0138 Web:www.co.san-joaquin.caus/ehd <br /> 1 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> O' 1/,�LRVI /' <br /> APPLICANT: C4 HUSINESwAGENCY: „(7�o r_O� CO <br /> rcezx <br /> ADDRESS: 3enc Al2r Gp/� p <br /> PHONE: 9 z 3 Z1 00 FACSIMILE: ! Z S 3 71 �J <br /> TENTATIVE*APPOINTMENT DATE: Time; <br /> (Please allow 10 buslnesa days from dste of appiioatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93,00 FEE—REQU PROC12S! D_Jfa 6 NESS DAYS <br /> SIGNATURE OF APPLICANT DATA~ <br /> DO02rtrnent US <br /> FILE ADDRESS UNIT <br /> ,. S1 3 c, _1c G [�y Unit 1 <br /> C G <br /> tr 2 O C Y n 2 <br /> e s O X e d c <br /> i Z o f <br /> O/'R et ca ` Unit 4 <br /> VAZI /^ a ❑ Unit 5 <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT t3 soUo WASTE FACILITY <br /> D OTHER CLEANUP Sar(NON-LOP) 1 0 FOOD FACILITY ❑ !soLID WAST$VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINCIRFMOVAL) ❑ DOG KENNEL, d FAIRY <br /> Q HAZARDOUS WASTE GENERATOR © CHICKEN RANCH 10 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOT1 1-fHOTE. 0 PUMPER TRUCKrYARD/CHEM TOILETS <br /> 0 TATTOO11300Y PIERCING 0 POOUSPA ❑ LAND USE APPLICATKM SI TRIS <br /> 0 ME111CA1.WASTE FACILITY 0 OTHER(PLEASR SPIECIFY) <br /> 1. List up to ten addresxes In the space aboVe. Select the type($)of files from the Ilat above by checking. <br /> the appropriate box(es). At least one file type MUST be*elected. Fax to(3091464-01;8 or mail to the <br /> adq gss indicated a ove. <br /> 2. EHO will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bustiness days but no later then ten (10)days after reCelpt 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 an by EHO staff may not 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 some condition as released willbe reorganized by EM13 staff'at the expense f <br /> of the applicant. Future file reviews by the same applicant may require a$23.00 daposit prior to review. <br /> S.- '''TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3!00•pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT GATE TIME <br /> PATE CONFIRMET.I PHONE . FAX- INfT1AL5 _ <br /> REVIEWED YES NO REVIEW DATE; <br /> • ereRvo� <br />