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04/05/2004 09:27 9252836121 AFI CONSULTANTS (SF) PAGE B j <br /> D REQEWED DLO ! <br /> SAz+JOAQUEv COUNTY � �H � <br /> )ENVDtONMENTAL HEALTH DEPARTMENT <br /> APR 0 7 2004 304 E Weber Ave 3"d MoorStocktoxl, CA 95205 <br /> Qq468-3420 Fax: (249) 464=6138 Weh:www.co•san joaquf,..ca us/ehd <br /> PERf�'IT�c"",' '.. _ <br /> PUBLIC RECORDS RELEASE APPLICATION 1 <br /> APPLICANT: • RUSINESSIAGENCY: 1y=1 ?� <br /> ADDRESS: <br /> PHONE: FACSIMILE: )- oc p�jLP � <br /> TENTATIVE*APPOINT MLNT DATE:__qbloq Time: <br /> (Please allow 10 business days from date of application subm�tuaQ <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS !p <br /> SIGNATURE OF APPLICANT /`rte DATE <br /> Depart nerit Use Only <br /> 0. FILE ADDRESS UNIT <br /> [] Unit t <br /> 4 <br /> 2 (7 p <br /> 3 S. Ei Dordd2 C11y <br /> Unit 2 i <br /> S' ' so- 5. Q-01KC St Unit 3 <br /> s. i q-1 S,I~I pt fdAo c li i <br /> u � <br /> a <br /> !I C <br /> Lrza �1 _ Unit 5 <br /> ENVIRO>yMaNTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) Q HOUSING ABATEMENT � SOLID WASTE FACILITY � <br /> aTHER CLEANUP sn-E(NON-LOP) ❑ r000 FACILITY SOLID WASTE VEHICLE <br /> X UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCID )Z, PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY © MOTEUHOTLL I] PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING ❑ POO ISPA AL LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILrrY ❑ OTHER(PLEASE SPECIFY) } <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list aboye Dy checking " <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or matt to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist; An appointmentfor review will be confirmed <br /> approximately 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 EHO staff tray 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 same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. '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 /> CQNFIRMED APPOINTMENT DATE TIME - ,;" : "` - °'": ` <br /> �c:,k•:x^a 4 <br /> .` FAX.U1FIRME[].SATEiNINITtAL:S`:f' :t <br /> REVIEWED- YES NO FREVIEW DATA - <br /> ' E}IO 48.1 -006 <br /> CIE�3003 <br /> t <br />