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08/12/03 TITS 09:56 FAX 19258272029 SHAW E & I �j��y ;, ._ <br /> tVY V1.70 ENVIr�IMENTAL HEA" PACE 01 <br /> DATE RECEIVED -- i} le anu LW nutrarr% <br /> SAN JOAQUIN COOCrY�' <br /> EN'VIRONWNTAL HEALTH DOS . #tTMENfi <br /> 304 E Weber Ave 3 Floor Stocktc:tx,CA`95205 <br /> (209) W8-,3420 Fax: (209)4640138 Web:www.C-C'. m joaquin.ca.us/chd <br /> X10 <br /> :PUBLIC RECORDS RELEASE,:0PLICAT'ION <br /> BUSINESSlAGENCY:_&�;,q0, IR.�l��u�G .;,,yrG,• <br /> ADDRESS: <br /> PHONE; J U FACSIMIL.E <br /> 'YENTA TTVE*APPOWiTMENT DATE: S --2/, nmd; <br /> f <br /> (Ptegae allow 70 hualness dsy8 front pate afapl:llcetlan bub�ilial) , <br /> s <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BU31N&SSf DAYS <br /> SIGNATURE OF ADPL!C J �} ' DATE: <br /> Deoem hent Use Cmiy <br /> FILL ADDRESS II. ;p UNIT <br /> z. t s CKi2i �a p ❑ Unit t <br /> 4. ❑ Unit 2 <br /> unit 3 <br /> e st'am <br /> Cite <br /> N <br /> j' Unit 4 <br /> Ptr Unlit <br /> fD. 3 t - i i� <br /> 1I� I <br /> ENNIRONMENTAL HEALTH DEPAR' IAEN I FILES <br /> UNDERGROUND TANK(L Sfi)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE WON-LOP) 0 FOOD FACILITY 13 $01-10 WASTE VELE <br /> 9K UNDERGROUND TANK(h ON IT'ORINWREMOVAL) A DOG KENNET. d DAIRY <br /> CT HAZARDOUS WASTO GEI IERATOR 13 CHICKEN RANCH CI PKQ TRRATMEM•PLANT <br /> C3 TIERED PERMITTED FAO CITY 0 MOTELMOTIM I= PUMPER TRUCK(YARDICHEM TOIL M <br /> D TATToaBODY PIERCING C] POOL JPA I; O LAND Use APPLICATION srrEs <br /> C3 M4DICAL WASTE FACIL11Y d OTHER(PLEASE SPQC4VYI f k <br /> `i <br /> 1. List up to ten addresses In the space above. Select the types)of filaiOrnm the list above by checking <br /> the approprial a box(as)_ At least one file type MUST be selo(,:ted. Faxto X20)4641-0438 or mai!to-the <br /> addraps indiIted above, <br /> 2. EHp will riotltr the applicant if any EHD fltes exist. An alppcal lltFri'erlt for review will be confirmed <br /> approximately five business days but no later than ten(10) d;ay 'a rrecelpt of application. The tiles <br /> will be held fo•a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is at lively being worked on by EHD staff MAY not tie Immediately gVallable for review. A new � <br /> application m;y be submitted when the Elie is available. <br /> 4. Any file not re mored In the carne condition as released will ba reorganized by EHD staff at the expense <br /> of the appiical It. Future file reviews by the same applicant ITIay require a$93.00 deposit prior to review. <br /> 5. "TENTATW a ppointment slates must ba eanfirmed with EHCI staff, <br /> 6. Applications r.►oalved after 3:00 pm will be processed the 11?,1 basin 's day. <br /> COWIRMED App61NT MENT DATE <br /> PATI;CONFIRMEbPHONE i�l'LX:i 1NITIAE.S <br /> REVIEWED `r Es NO REVIEW I'M Er <br /> 40 ,,. <br />