Laserfiche WebLink
DATE RECEIVED LNV1KUNMLNIAL ALTH PAGE 01 <br /> SAN JOAQUIN COUNTY - <br /> &,77IRON ENTAL HEALTH DE ARTM,"KT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> AUG 16 2004 ST Otos)4N68-34205202 <br /> ` J <br /> 8�qo Ct�� \\a2, <br /> FNVIRQNMENI h ;J, ' PUBLIC RECORDS RELEASE APPLICATION ) <br /> PERMIT/,q77' t- ���-Q--S-Zi BUSINESS/AGENCY Gy C®`, <br /> APPLICANT)ILr 7 i � :\\Cl.r� �- Y`ny��nh� I J� <br /> AODREss _AA�'y 1� S c �r ds Sfi� Ch '�I S 3 S H rQc hn.-<S <br /> •PHONE Z O"\ 2_Z `j�\ FACSIMILE 2 u CA <br /> vl •\\ SchQ�,ti\5. <br /> TENTATIVE"APPOINTMENT DATE C?n cP s ;an 1_ n..t~.o PS_'axR TIME <br /> (Please give 7 to 10 business days from data of application submittal) oil X�CHECK BOX TO E%PED11E REQUEST-S 0 FEE-REQUEST PROCESSED IN 3 BUSINE33 DAYS ` <br /> •SIGNATURE OF APPLICANT 7c �V c3 - DATE g ` 2 I� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> \-LO c ZOv Lop', <br /> `-4a co, •� a.\ Lvd' i� �I ill°O,�rJ..�i) <br /> Look.' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> • UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> • OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> b UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> • HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKrYARD/CHEM TOILETS <br /> ❑ TATTOOMODY FORCING O POOLISPA O LAND VSE APPL.1�A�TION SITES <br /> ❑ MEDICAL WASTE FACILITY /A I <br /> OTHER(PLEASE SPECIFY) '1 G,I-P r(i!'P S�A-P <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. 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately avallable 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 /> of the applicant. Future file reviews by the same applicant may require a$89.00 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. f� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWoED YES N/O. - L REVIEW DATE <br /> neersmi�-4 , ' �ly CQ- <br />