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09/19/2002 16:03 209--579-2225 MODEST❑ ATC PAGE P <br /> SAN_ JOAQUIN COUNTYPUBLIC HEALTH Si=RV1CC5 <<N <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 )CAST WF-58R AVENUE,THIRD FLOOR D <br /> 00 STOCK' ON CA 95202 <br /> f (200) 468-3420 <br /> f PUBLIC RECORDS RELEASE APPLICATION 19 2002 <br /> l <br /> APPLICANT / BUSINESSIAGENCY /47& 14Ss4C-1A FNMENT HEALTH <br /> ADDRESS /ll7 Zo"&l Ai-m4} ) Q IVIDAes IT15ER ' <br /> PHONE FACSIMILE Czb9,) <br /> TENTATIVE'APPOINTmr-NT DATE_ ._�Q�Tf d Tr TIME _ �Q: AIPK, _ <br /> (PIcaso bsve 7 to 90 bus'in�yr,trn dale of;p1il. allon aubmillal) <br /> C3 CHECK BOX TO,CXPEDrm Rrz. S7- M RC UE: P. • NUSINQ55 BAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 11 <br /> LLC > ST.yj 7 } <br /> ALL <br /> U <br /> dAAgplei <br /> T L Al <br /> N11 <br /> LOA <br /> ,fl <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ADATI:MENT 0 SOOD WASTE FACILITY <br /> OTHER CLE•A14UP SITE:(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNOCRGROVND TANK IMQNTTORINGIRI:MOVAL) O POG KENNEL IO DAIRY <br /> HAZARDOUS wA5Tr G£NGRA'rOR to CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIERED PERMLTTCD FACILITY O r40TEUHOTEL ❑ FVMPERTRUCWYAKD1C1iEdi7oILM <br /> O TATTOOIBODY PHIRCING EO POOLISPA Q LAND USE APPUCATtON SITES <br /> O MEDICAL WASTE`.FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the. space above. Select the type($) of files from the list above by checking <br /> the appr "riate box(es). At least one file type MUST be selected. Fax to (2091464-038 or mail to the <br /> address )ndicated above. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. 7hc 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 bring worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the Nle is available. <br /> 4. Any flle not returned in the sarne condition as ralCaScd will be reorganizod by EHD staff at cite expense <br /> of the applicant. Futurc file reviews by the same applicant may require a$07.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 61 Applications received after 3:00 pm will be processed the next business day. ` <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> __...�...�. .,Y . n o"ir-w OATS vim. <br />