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AEC-13-2004 12:53 CONDOR EARTH TECH 209 532 0773 P.01i0: <br /> PATE RECENED _ EHD LOG Nl1h <br /> SAN JOAQUM COUNTY . <br /> FN^VIE ()NMxNTAL HFALT$DUARTMENT <br /> DEC 1 , 2004 304 E Weber Ave P FIoor 5tock#on, CA 95245 <br /> (209)468-3420 Fax: (2-09)464-0138 Web:www.co,san joaquin.ca as/ehd <br /> ENVIRiIib;� rL;;L�N <br /> PERMI1 "-R`r'ICES PUBLIC)RECORDS RELEASE APPLICATION <br /> JPA <br /> APPuCAiVT: ..�$'�Lf�Cl�,�,,��euswlara�Nc�r: � <br /> ADnR�ss: NQ <br />' PFiAN FJ4CSIMiLE C 1 <br /> TENTATIVE'APPOWT -iD A <br /> (Pieme allew IQ i:odm=days frac dada of asap aubmat* <br /> cm=soxTomwwjMOO --REQUEST PROCESSM IN s BUSUMS8 ?`T <br /> SIGNATURE OF APPLICANT DA-T,41 13�Vic.a7Qd4 <br /> Depanl ud Use ONy► <br /> FtE ADDRESS UNI[ <br /> +. a Ej UnR i <br /> >jY& <br /> ,. 1 <br /> eamr UnR S <br /> LPE"T6-r?- b <br /> r_ swm STOn4=tj LATAIJ IKFd "r Unit 4 <br /> N o VIN Co, rte* yol2 -I S -r _ �` <br /> I s. stens ON 7tG RA« ' S I" Units 4l <br /> �`J <br /> /� <br /> ENVIRONMENTAL HEALTH DEPARTMENT t <br /> XtoNax- <br /> kr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING AIRA EN[ r SOLIC wAS'TE F <br /> OTHER CLEANUP ME(MON-LOP) `- 13FOOD FACILlr1r SOLD WASTE <br /> UNDERGROUND TANK( 0NCTORJNG1REMOVAL) 13 DOG KENNELAf <br /> DAiKY <br /> HAZARDOUS WASTE GENERATOR 4P CHICKEN RANCH d PKG TREATMENT PLANT <br /> TIERED PERNMED FACILITY CI NOTEUH07EL ❑ PUMPER 3RUCKMARDMHEM T01-M <br /> ❑ TATMK)MODY PIERCING D POOLISPA J9 LAND USE APPLK.ATION SM <br /> JZ MEDICAL WAm FAc&Hy 17 OTHER 04XA9E SPEWYL...... <br /> 1. List up to ten addresses in the spade above. Select the type(s)of fries from the list above by dweldnt <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed <br /> approadmately five business days but no later than ten(10) days after receipt of application_ The fifes <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 may not be immediately available for revlew. A nes <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 fife reviews by the same applicant may require a$93.00 deposit prior to•reviey <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3.00 pm will be processed the next business day. - <br /> CONFIRMED APQOINT ENT DATE TIME <br /> DATE CONFIRMED 'PHONE • FAX' 1NITfALS'' <br /> REVIEWED YES NO REVIEW DATE' _ <br /> TOTAL P.O-' <br />