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04/06/2005 09:56 FAX 209 948 ' Rl002/002 <br /> CiIW LVV 1'1VIN•��+ <br /> PATE RECEIVE[) S.kN JOAQUPi COUNTY <br /> �3E k��� I/ �ENv� 0-N-.NJY- TAS-. EAz,��DEPAz TKENx' <br /> 304 E Weber Ave 3`' Floor Stockton, CA 95205 14 <br /> 6 ?u`�09) 468-3420 Fav (209) 464-0138 Web: www.co.sau joaquia,ca-&abad <br /> I & 7 <br /> EWRO'it'EN-1 HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ApPucaasT: Std ElUSINI;SSIAGENCy. <br /> ADorz�ss: � ` <br /> } FACSIMILE: B+CCvdl3 <br /> TENTATIVE"AppOINTMENT DATE. Tlme <br /> (Please allow I LSusine-es days from date of applic2ticri suhmi=l) <br /> CHECK 60X TO t'](PEDITE gEQUEsT-$91.110 FEE-REQUEST PROCESSED IN:I BUSINESS GAYS <br /> DATElr,� <br /> SIGNATURE 05 APPLICANT p�p3rt+nentt}se OXY <br /> - U NIT <br /> FLLE ADDRESS <br /> 5C L ❑ Unit 1 <br /> G 44 <br /> 1 R, Ciunit 2 <br /> I <br /> jIII. ShI „ Unlit 3 <br /> � G <br /> S, SYrett <br /> G � <br /> Unit 4 <br /> V G ,1 <br /> oo El Unit 5 <br /> - <br /> td. Saes ✓'1 aaJ � ,� � 'T )L <br /> J' - ENVIRONMENTAL HEALTH 6EP 7MEN FI 5 <br /> RL Souo WASTE FACILrTY <br /> UNDERGROUND TANK(UST)C1_FANUP SME(LOP) L] HOUSING FACIT-FFY=MEIrr ❑ SO❑D WASTL VEFi1CLE <br /> OTHER CLXJ NUP Srrl=(NON-LOP) ❑ FOOD LNNIL TY 1� DAIRY <br /> a UNDERGROUND TANK(MONITORINGIF-r=M V?Z} ❑ cHI KENNAL �.PKG TFT-ATMLST PLANT <br /> jZ RA7p+RDOUs WASTE GENERATOR Q C1iIGKEN RANCH <br /> ❑ MOTELhIOTEL q PUMPEft7RUGKIYARD1GliEMTOtI--f='45 <br /> ❑ 'OER1=4 PERMrrtcD FACILM p FOOLISPA la LAHO USE APPLICATION SfTES <br /> 0 TATTOO+UOLSY PIERCING ❑ OVER(PLEASE SPECIFY) <br /> Q MfOICALWASTE FAC ILrrY <br /> s of files from the list above by checking <br /> 1, List up to ten addresses in the space above. Select the type(s) <br /> the appropriate box(es). At least one File type MUST be selected. Fax tp 209 484-0138 or mail to the <br /> address.indicated above" <br /> z. E}ID will notify the applicant if any 1=iiD files exist An appointment for review will be confirmed <br /> approximately five businass days but no later than ten (10) days after receipt of utdApplication, <br /> he soh , The files <br /> will be held for a maximum of five business days for review- Appointments should be scheduled <br /> accordingly. available for review. A ne` <br /> 2, A file that is actively being worked on by EHD staff May not!,e immediat4ly <br /> application may be Submitted when the file is available. <br /> be reorganized by EHD staff at the expen <br /> 4. Any file not returned in the same condition as released Trill evie <br /> of the applicant. future file eviews by <br /> must the -name ed with EHDay require a $93.00 deposit prior to r <br /> 5. "TENTATIVE appointMent dates <br /> g, Applications received after 3:00 pm will be processed the next business day, <br /> -CONI= <br /> . <br /> •TIME <br /> INT <br /> :' ;: •INITIALS _�� <br /> PHONE FAX <br /> ; <br /> DATA c o H F'1R'F=c>' <br /> REVIEW DATE= <br /> REVIEWED YES NO <br />