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Q2/15/2005 16:29 2096342883 FEDEXKINKbS PAGE 02/02 <br /> DATE REcEmD SAN JOAQUIN COUNTY EMD LOG NUMBER <br /> ( f I.��VD <br /> Lf 11� j D � � <br /> r� TNviRom IEN'I'AL HEALTR AEpARTA�NT <br /> 304 East Webew Aymue,3`d Floor,Stocktce,CA 95202-2708 <br /> FER 1 5 70D5 TdcpbOIW(209)468-3420 Fax:(209)464-0138 Web:www,sjgov.org/dd <br /> ENVIRQU-r- PUBLIC RECORDS RELEASE"FLICATTONPk � - <br /> W o,✓t ,t2,n I3LISIN6551AQE74CY: A�;X L1NViJ�� <br /> ADDRESS:_ ��`� Vt.� �t ��U� (ur(4CK CR qS3Y3Z <br /> PRONE(2).: , iZX'A'�f �o� i]� FACSM LE: <br /> TENTATIVE*APPOINTS Nt DATE: x-12` 05 d 9 cap <br /> (Pleaxe c5ow 10 business days from dote of cpplicction subm tw--TMM VC ordy-must be eonflirw� <br /> ❑ CHECK BOX TO EXPEDITE REQuEsT-$913.40 IEE(CASH OR CHECK ONLY)-REQVEST PROCESSED IN 3 BU MMS DAYS <br /> SIGNATURE OF APPLICANT DATE _ Z ( �� <br /> Um INSTMVTTON 4 LkA 1 ❑(hitt 2 ❑Unit 3 D ung 4 ❑tlydt 6 ❑ Unit S Q Ottxx(etxctrvttidtistah,mps) <br /> FILE ADDRESS END USE ONLY <br /> stront p street Nam Cay <br /> 2 <br /> 6. <br /> 7. mtlqq <br /> SPeaMo Date Rattifes of InforTii' tkm Rcquastad:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PCW-MMM M TANK(UST)CLEANUP Sm:(IAP) O Mom=ABATEMENT ❑Som WASTE FAcLrry/VBwCI.E <br /> 13 OTHER CLEANUP SITE PION4.M ❑F000 FAcmty 13 WASTE TIRE <br /> ❑tkmMFtOUNDTANK(MOMTOR RiOYAL) O DOG KeJ4tEL ❑DPRY <br /> d HAZARnous WASTE 99CERAT01t ❑CHnKEN RAPWH 13 WASTLIWATM TREA,TURWr PLAKT <br /> 13 TIEPM PEJ=TTPD FACRrTY ❑mTajHotEL ❑PtizXPM TRUC10YARdCKM Tb&ETS <br /> O YATwolBoar Pttmcm ra PoouspA ❑LAND Um APPucAnoN Sffgm <br /> ❑tUowALWAzim FAmmy 17 OTHER(PLEASE SPODWY) <br /> WELL AND SEP=PEmm RewRD3 ARE AvAxABLE wR REvWW- l dow AYfm7DAY 9:00 M.6 o0 Pbt - eraLubm HOLIDAYS. <br /> I. List Up to ten addresses in the space above. Select the type(s)of files from the list above by Checking site <br /> appropriate box(as). At least one file type MUST bn selected. Fax to 01454-0138 or mail to the address <br /> Indicated abme. Address ranges Will not be accepted—for additional assistance faith file addresses,contact <br /> the END.Applications received atter 3:00 pm will be pfocessed the next business day. <br /> 2. The EHD will noft the gmlicknt if my EHD filoa ox1vt. ,An a;tppointmwnt for roviow will be eonfirtrldd <br /> apprOXlmB¢*ten(10)d%"3 alter receipt of a ppllcatio(t. The files will be held for a maximum of five buslnass <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A tyle that is actively being vxwked on by EHD staff trra3ty 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&arae condition as re kwed will be reorganized by EHD staff at the expense of the <br /> applicant Future file,revl2ws by the same applicant rrtay"mire a$93.00 deposit prior to review. <br /> jn4M zoos <br /> inuon <br /> i <br /> V t <br />