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IOJ28/2004 13:24 FAX 209 94808` 11002 <br /> DaREcsNED ^� SAN JOAQUJN COUNTY c V wV <br /> ENVIRONMENTAL HEALTH DEPARTMENT O <br /> 304 E Weber Ave 3b Floor Stocktort, CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.szn-joaquin.Ca-us/ehd 2 <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i?YSr BUSINESSTAGENCY: <br /> ADDRESS: <br /> W ;UEC <br /> = V <br /> PHONE:. _rpm -I Sr FACSIMILE; `O�� <br /> TENTATIVE*APPOINTMENT DATE: 4 A rano: 12 <br /> (Ploasa allow 10 business days Gam date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93M FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DePwtMent Use O,Ny <br /> FILE ADDRESS UNIT <br /> �, t7 us15>T� VZA ElUnit 1 �,}�oR N.ta.l6ow % +A Unit 25A-'1N- as Ito b Itm �s. , 3 Kao Unit 3 1\ <br /> s. >am uoo c <br /> �Unit4 n p <br /> a" sree 1 5 uJfl <br /> s. swx �S ck- A ❑ Unit 5 �• <br /> ,�. saw •.� C>4 M t(I y I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(uST)CLEANUP SITE(IPP) 0 HOUSING ABATEMENT ID SOLID WASTE FACILITY <br /> S OTHER CLEANUP SITE(NON-LOP) U FOOD FACIUTY U SOUR WASTE VEH1C� Q L <br /> t$ UNDERGROUND TANK(MOHIT0R1NG7R6MOVAg in DOG KENNEL 03 DAIRY I W {'r+� <br /> I§ HA7-kRDOUS WASTE GENERATOR U CHICKEN RANCH 0_ PKG TREATMENT PLANT <br /> 4 TIERED PERMITTED FACILITY LI MOTELIHOTEL Q PUMPER TRUCIGYANDrCHrU TOILETS� Q <br /> U TATTOOTBODY PIERCING O POOtJSPA a LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of Tiles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 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 /> 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 /> 31 A rile that is actively being worked on by EHD staff may 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 /> or the applicant Future filo 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 /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> 'G'ONF:llN1ED •APPOINTMENT"frATE '.' TIME �a i.•:.x� _ ,i.,:;A <br /> °°`r <br /> 6GO .?;t'PHONE .' FAX <br /> ;;x..,r7NFI7ALS �;`•:Yt :,. <br /> AATNFJRfa(�ED.� - y. � .• <br /> REVIEWED YES NO REVIEW DATE,' <br /> ' EHa e142A96 • _ <br />