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DEC. 8, 2003- 2: 16PM COUOR EARTH TECH NO 16971EHIP- INUMBER <br /> DATE RECEIVED SAN JOAQUIN COMM <br /> ENVMONZvffNTAL MALTH MPARTIVMN7 <br /> 304 F,weber Ave P Floor StocWn, CA 95205 <br /> 0 E468-3420 Fax: (209)464-0138 Web:'www.co-san-joaqum.caus/chd <br /> {Fl( BLIC RECORDS RUEASE APPLICATION <br /> b <br /> iL <br /> APPLICANT: IZII�Z­ &,,E'zsusiNEsS1AGENCY. <br /> :7 <br /> ADDRESS: JA C_tF- <br /> FHON <br /> FACSIMILE-' <br /> c 2 BJ <br /> 0Time; <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please aiiaw 10 business d;Wsircin date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST $93-00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> UN1rr <br /> FILE ADDRESS <br /> 11 Unit I <br /> Vz <br /> 3. Snel 2 <br /> x 34-C i at-7 3 <br /> S. Sheet <br /> .>, q <br /> MY W_ Ury loft <br /> .,tn ;Le \j Icyj <br /> nit <br /> Chy <br /> E 8 Uni <br /> 10. 9Ueat <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> V <br /> OTHER CLEANUP srrE(NON1-LOP) 0 FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0DOG KENNEL 13 DAIRY <br /> 13 PKG TREATMENT PLANT WASTE GENERATOR L3 CHICKEN RANCH <br /> 0 MOTEWHOTEL M PUMPER TRUCKIYARDIC M TOILETS <br /> TIE11ED PERMITTED FACILITY 0 POOLISPA E3 LAND USE APPLICATION 3 <br /> 0 TATTOO/BODY PIERCING AM <br /> 0 MEDICAL WASTE FACILITY El OTHER(PLEASE SP <br /> ek checking <br /> ad above. Select the type(s)of riles from the list aboy y <br /> 1. List up to ton addresses in the sP 0 list <br /> ""Jy 0�y <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209j;42138 o mail to the <br /> address indicated_above. will be Go firm;� <br /> 2. EHD will notify the applicant if any EHD files exist_ An appointment for review will be GOJ firmed <br /> approximately five business days but no later than ten(10)days after receipt of appilicaVion. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. r review. Anew <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available fo <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$93.04 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. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> ------- <br /> DATE CONFIRMED 'PHONE FAX <br /> REVIEWED YES NO REVIEW DATE' <br />