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AUG-23-2004 15:51 CI„"`OR EARTH -TECH 209 .1532 0773 - P.01/0: { <br /> DATE RECEIVED���, � EHD LOG NUI R V <br /> SAN JOAQM COUNTY <br /> L p' ENVMONMENTA.L STEALTH DEPARTIV,[ENT <br /> Zp04 304 E Weber Ave 3`'Floor StoclloT, CA 95205 <br /> ASG ' H <br /> €2pgI)1 468-3420.'ax: (209) 4640138 Web: w. <br /> wwco.sw-joaquiiLca.Wchd <br /> b'07 <br /> ACI <br /> �NV1RflN SERVI� S PUBLIC RECORDS RELEASE ARkLICATION <br /> ApPucnrrr: P t 4t�E susRNEswAGENcY: R <br /> ADDRESS: p, 0. N� +� <br /> PHONUej 67 FACSIMILE � <br /> -__—�.d�W <br /> - TENTATNE`APPoffnm LATE Time! ' <br /> Meme allow 10 business days from data of applleadon submluaq <br /> Q CHECK BOX TO EXIT=DITE R!+ VEST-$M.00 --REQUEST PRDCESSED IN 3 SUSRF M DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> f <br /> DepartrTte[It Use Only <br /> FILE ADDRESS i, UNIT <br /> �, anter $ <br /> p Unit 1 <br /> p BAY <br /> 1 a. 15L RRIo ti i3 Unit C � <br /> S. s 66 �r ✓ (. Unit 3 �,� <br /> z. sc� SPR P-M1+57 Unit4 <br /> L d'_ 56> ` <br /> s• T.f Z o�S Unit 5 <br /> � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FtI.ES ' n . <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT (F SOUL)WASTE PAC1Ln Y <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FooD FAcILI Y SOLID WASTE;VEMCLE <br /> UNDERGROU D TANK(MONITORINGIREMOVAL) 0 DDG.KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN PANC I 0 PKG TREATMENT PLANT <br /> TIERED PGRmimn FACam 0 MOTELIHOTEL M PUMPER TRUCMARWCHEM Tb1I-M <br /> ❑ TATTOOMODY PIERCING 0 POOL ISPA PIr LAND USE.','APPLXATION SMS <br /> d MEDICAL,WASTE FACIL MY ❑ 07KER(PI.ME SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(a)of#Iles from the list abc ye by checkirn <br /> the appropriate box(es). At least one Elle type MIDST be selected. -t 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHO files exist. An appointment for 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 EHD staff may not be Immediately-available for review. A ne <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 stiff at the expens <br /> of the applicant. Futum file reviews by the same applicant may require a$93.00 deposit prior to-reviw <br /> 6. *TENTATIVE appointment dates must be confirmed with EHD staff <br /> - <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> �4 , <br /> CONFIRMED APPOINTMENT DATE TIME I <br /> DATE CONFIRMED PHaH1= . FAX INrn LS- <br /> REVIEWED M YES NO REVIEW DATE <br /> TOTAL P.O: <br />