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•Fm]n P, .Environmental PHONE NO. : 209 369 4228 .TLAq. 11 2003 11:05AM iaesa <br /> II SAN J09QUIN COUNTYPUBLIC HEALTH SMV10ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 1 1200s 304 EASTWEBER AVENUE,THIRDFLOOR /vl <br /> STOIXTON CA 95202 I <br /> 1 NVIRONMEiNT HEALTH (=09)468-3420 <br /> PFRrL1L==RV��Ir.r��0 P'U'BLIC RECORD. RELEASE APPLtCA� ION__ _ <br /> APPLICANT 6;ie- /�pLCJC,M// BUST/NI.SSfAGENCY ,fU <br /> ADDRESS/ fZ'tJ5'Y'0LL L_!' LQL7 <br /> PHONE 1�5� 7-37a/ FAcslaelLE .zA4 3G`(— 7Z.f��..__ <br /> ( '_'--._.— ea' lid <br /> TENTATIVE*APPOINTMENT DATE �l /4,% 3 TIME9_4:�-•;..• <br /> (Please give 7 to 10 businoas ays n date of appllration submitl Itj <br /> Ey CHECK 80X TO EXPEDITE AEOVE.y9T�-,S.B9.00.FEE- O11E3T PROCESSED IN 3 BUS1NEaS DAT", W,1- .3 . ('2 <br /> SIGNATURE OF APPLICANT L /` DATE <br /> FILE ADDRESS TH13 SIDE E NO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> — <br /> god �. d°c kk <br /> J So. Gla <br /> Arc. ( U Lj,,g Aj t4S� --- —� <br /> if <br /> 00z 135.a <br /> c <br /> flel <br /> M --- -- <br /> ENVIRONMENTAU_HEALTH DIVISION FILES <br /> NC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT Cl 1;OUC-WASTE FACILITY <br /> Ir OTHER.CLEANUP SITE(NON-LOP) ❑ F06D FACILITY CI SOUL WASTE VI?HICLE <br /> � UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOC;KENNEL Cl IIAIRY <br /> ❑ HA2ARDOUS WASTE GENERATOR ❑ CHIdKEN RANCH U F'KG 1 RCATME Tr PLAVT <br /> ❑ TIERED PERMn-MI3 FACILITY ❑ MO"EUHOTEL C1 PUMP ER TRue KNAAn1CHER TOILETS <br /> ❑ TATTOOIBODY PEIRCING O POOLtSPA Cl LANG USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUE'UC WATER SYSTEM CI oTHE-a(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files fro n the list above by chocking <br /> the appropriate box(es). At least one file type MUST be selected. Fax toS.10 )484-0138 or mail to the <br /> address indicated above. . <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for re-rievi Will be confirmed <br /> approximately five business days but no later than ten (10)days after rect!lpt of application. Thn files <br /> will be held for a maximum of five businet s days for review. Appoinbnents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by I:HD staff may not be Immediately available for review. A new <br /> application may be submitted when the fila is available. <br /> 4. Any file not returned in the same condition as released will be reorilanized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a !;09.00 deposit:prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> e. Applications received after 3:00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INmAI_S <br /> REVIEWED_ YES _ NO REVIEW DATE <br />