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06/20/02 THU 15:18 FAX 55tNV <br /> 108 SECOR PAGE 0'I <br /> 26/20/2002 14:26 46401` EIRONMENTAL H <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SEZZICES <br /> r�, <br /> ENVIRONMENTAL HEALTH DIVISI®NI 304 EAST WEBER AVENUE,THIRD FLOOR02 <br /> STOCIT6N CA 95202(209)468-3420EALTHPUBLIC RECO DS RELEASE APPLIC <br /> APPLICANT BUSINESSIAGENCY_SEC,n "Uft ,��,.N � :w•t A� i.W� <br /> ADDRESS LJ- ,Aw U 04 1 <br /> PHONE �f_ ��(" 2&40 FACSIMILE. —i�^1l— 5-10 <br /> TENTATIVE*APPOINTM9NT DATE G 27-02 T"AE 147;Od <br /> (Pleas®give t0 10 business days froma of appll tlon submittal) <br /> dowwo da <br /> Ar %ft am <br /> CHECK Box TO EXPEDITE PEQUEST-SV. F#-FR6E&1ESTW!iCA61PI a ASINESS DAYS <br /> SIGNATURE OF APPLICANT _ ��- _:.�-�"` DATE <br /> FILE ADDRESS THIS SIOR EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> d �' r`i.e� c.•4 A• si '� <br /> I Minh <br /> Y4-r-f tial ra••tt -(- c,(C. ---- - <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ASATMENT 0 SC)Uo WASTE FACILITY <br /> THER CLEANUP SITE(NON-LDP) ❑ FOOD FACILITY 0 SOI.•ID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 0 Doo KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RAIMON 0 PLCO TREATMENT PLANT <br /> 0 TIERED PERMnT6d FACILITY 0 MOTELIHOWL 0 PUMPER YRUCIVYARDICHEM TOILETS <br /> CI TATTOOMODY PEIRCING 0 POOLISPA M LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUDUC WATER SYSTEM a OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the types) or files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. 9Z So(2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHID 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 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 EMD staff at the expense <br /> of the applicant. Future file mviews by the$21718 applicant may require a$99.00 deposit prior to review. <br /> 5. *TENTATIVE dppoInIM0li dateS.nULAt tsts aaae�e�•-s+-•�"'. w,�•--- — -- — <br /> 6, Applications recei * ' <br /> Post-ir Fax Notq 7611 DOW <br /> TO From <br /> CONFIRMED APPOINTME �• <br /> # phowa � ^'Ir'F9 >LS <br /> OATS CON{~iRNIED � •---�°— <br /> x# , Fax# e;3 <br /> REVIEWED YES <br />