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03/17/04 15:54 FAX —. <br />n1� `mo i J SAN JOAQ I N COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />LIAR 1 7 2004 304 E Weber Ave 3`d Floor StOCkt02l, CA 95205 <br />ENV(209) 468-3420 Fax: (209) 464-0138 Web: www.cO.san joagwnoa us/ehd <br />QhnjjIEISEE HEALTH <br />ERMITRVICES PUBLIC RECORDS RELEASE APPLICATION <br />U001 <br />EHD LOG NUMBER <br />r <br />#37 <br />P e <br />APPLICANT:CVAA <br />aVsYt�x b` �"" �N—BUSINESSIAGENCY: <br />ADDRESS: 7 p t�d` rf 83 8 <br />PHONE: 00 i( 2SY PACSIMI z <br />TENTATW APPOINTMENT DATE: _A_S" Time: R <br />(Please allow 10 business days from dab' of appllc tion submlttall <br />CHECK BOX TO EXPEDITE REQ7��Z� <br />FEE REQUEST PROCESSED IN S BUSINESS DAYS a -I <br />PATE <br />SIGNATURE OF APPLICANT Department use OpN <br />HEALTH DEPARTMENT FILES <br />UNIT <br />Unit 1 <br />Unit 4 <br />Unit 5 <br />ENVIRONMENTAL <br />sou0 WASTE Aclutl <br />UNDERGROUND TANK iuST)cLEANUP SITE (LOP) HOUSING ABATEMENT SOUOWZTEJ/EIIICL, <br />OTHER CLEANUP SITE (NON -LOP) FOOD FACILITY M DAIRY <br />UNDERGROUND YANK (MONITORINGIREMOVAL) CH �i KENNEL <br />PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR � CHICKEMOTFLJN RAN PUMPER TRUCK/YARDICHEM TOILETS <br />3T TIERED PERMITTED FACILITY p POOLISPA to LAND USE APPLICATION SITES <br />TATTOOI90DY PIERCING ❑ OTHER (PLEASE SPECIFY) <br />MEDICAL WASTE FACILITY <br />1. List up to ten addresses in the space above. Select the type(s) Of Iles from the listabove rby <br />C e theg <br />the appropriate box(es). At least one file type MUST be selected. Fax o f20914G' <br />_a.Less indicated above,ointment for review will be wnfirmed <br />2. EHD will notify the applicant if any EHD files exist An app <br />approximately five business days but no later than ten (10) days after receipt <br />thou d be cheduledof application6 The files <br />will be held for a maximum of five business days for review. Appor <br />accordingly. <br />36 A file that is actively being worked on by EHD staff may not be immediately available for review. new <br />application may be submitted when the file is available.EtID staff the <br />4. Any file not returned In the sante condition as releasedwill be reorganized equire a $9 y 0 deposit t or to rev ew. <br />nse <br />of the applicant Future file reviews by the same applicant <br />5. *TENTATIVE appointment dates must be confirmed with EHD staff. f <br />g, Applications received after 3:00 pm will be processed the next business d <br />CONFIRMED API <br />DATE CONFIRMED <br />REVIEWED YES. NO; <br />-.PHONE <br />TIME <br />--------------- <br />FAX, ' '..INI7711LS <br />W DATE' <br />