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Dec 08 04 02: 37p Hanover Inc 530 342 1490 p. 2 <br /> r17—Ul <tJkJel ego .....• <br /> ENO LCG NUMBER <br /> • ���r l'- ' ',` f5A1V JOAQUIN COUNTYPUBLIC HEALTH SE ICES <br /> _._ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 8 2004 304 EAST WEB KTON CA 9520 RD FLOOR 115&9 <br /> 570CKTON CA 95202 <br /> C5!t;�q1J �1A l (209)468-3420 <br /> plr � ?UBLiC RECORDS RELEASE APPLICATION <br /> APPLICANT � Y17i' 'B 'n' C � BUSINESSfAGENCY4-1 h+`-f2y <br /> ADDRESS-10,72, <br /> 2t(-�}a'ra�.nr�Er Sl, <br /> ✓ <br /> PHONE�Q"�L.J 't Z- 135� FACSIMILE 5�• 34 a• I 9 p <br /> 12 7'4I q TIME 1: 30 <br /> TENTATIVE APPOINTMENT DATE -- <br /> (Please aloe T to 10 ueiness days from date of appfl"ton submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$61.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS r , <br /> SIGNATURE OF APPLICANT ' DATE <br /> FILE ADORE9S IS SIDE EHD STAFF USE ONLY <br /> ROG ELEMENTS SEARCH <br /> SfoL(407 r <br /> -19;L h)• An+e_rOS <br /> s 2 r N1. b r;nl- <br /> 21c30 =� Fre,r'non <br /> AM <br /> R'� Miner AJ.c. ✓)'I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> C•'Jr/,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MoNCTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> L% HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY U MOTELlHOTEL ,. CI PUMPER TRUCK/YARDlCHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA "' ' ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM U OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files 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. FHD 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 /> wild 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 new <br /> applicvtion may be submitted when the file is available. <br /> 4. Any fiat 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 $87.00 deposit prior to review. <br /> 6. "TENTA•i,IVE appointment dates must be confirmed with EHD staff. <br /> B. Applicat!Qns received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT BATE TIME <br /> DATECONFIRMED PHONE. FAX. INITALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTRL P.01_ <br />