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10130/2000 12:20 213940 - <br /> FIFTH FLOOR � ajE <br /> V P2 <br /> SAN JOAQUIN COUNTYPUL'LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION OCT 3 0 2000 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 57TOCIKTON CA 95202ENVIRONMENT HEALTH <br /> {2o�a 4U-3420ENVIRONMENT <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CANT -•lain i~I7r��F BUSrAESSIAGENCY <br /> APPLI t <br /> ADDRESS/ i W S3 l2• rfi rs4-f-I 0 IV4d• j <br /> PHONEY�t.� ! Bd FACSIMILE <br /> G� F17a <br /> ? <br /> TENTATIVE*AppOINTtAENT DATE G CTS TIME1�/�r Y I y cU <br /> (Please Dive 7 to 7 D buslne days from dater of application sp�ttlttal) j <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE.-REQUIES SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE fa 3+ da <br /> -- -- x - THIS 510E EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAMELENIEN- S CH <br /> 1. Z- <br /> J\ <br /> I2 6, C �! _ <br /> 1-10-f FO un)Ib - - -- <br /> �c` i <br /> C� D <br /> ENVIRONMENTAL HEALTH DIVISION FILES D <br /> UNDERGROUND TANK(UST)CLEAKUP SITE(I-OP) 17 HOUSING ABATEMENT Q SOLID WASTE FACILOpdD <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY [3 SOLD WASTE VEHICLE <br /> XUNDERGROUNID TANK(MONITORINGAIEMOVAL) 0 CHICKEN RADOG KEN RA t7NCH 13 KG PT NOV _Z mo TREATMENT PLANT <br /> cl HAZARDOUS WASTE GENERATOR ❑ MOTELJHOTEL ❑ PUMPER TRUCKNARDICHEM-FOILET3 <br /> ❑ TIERED PERrdITTED FACILITY O POOLISPR O LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCiNG ❑ PUBUC WATER SYSTEDA 11 OTHER(PLEASE SPECIFY ABOVE) <br /> O NIEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list alcove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209 454-0 38 or mail to_lhe <br /> address irdicated 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 ma)dmum 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 /> 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$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:04 pm will be processed the next business day. <br /> FAT <br /> ONFIRMED•APPOINTMENT DATE _71WE <br /> E COIdFttifllED PHONE FAX, INITIALS <br /> REVIEWED YES NO REVIEW CA,TE°._ <br /> Eli 0414 MOM <br />