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o-ter Prca�co c+w>.orwwex <br /> DEC 151999 SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISIAN <br /> ENVIRO NMF-" " � t '�ALTH 304 EAST WEBER AVENUE THIRD FLOOR <br /> PERMIT / SERVICES ST°z�ON CA 20 92 <br /> /• PUBLIC RECORDS RELEASE APPLICATION <br /> APF'UCA7IT Jai/•ti [t15 it Nl�"�— BUSINESSfAGENGY 61 <br /> ADDRESS 1 ,54, $.• t.r J AA f. <br /> PHONE l ��� �I'I fi— Li �--C �) _ FACSIMILE�ZC141 If. 11 - f- Z <br /> v : <br /> TENTATNE'APPOINTMENTDATE l d. -ZTIME J U Po M <br /> (Plsase Give i Lo l0 irteaa 6 a from tlale of epp[icrtion autwniltal) <br /> CHECK BOA TD EXPEDITE REQUEST•$Ta.00 FEE-R/[�T P p[s3ED M 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� / ^ Lf— DATE <br /> FILE ADDRESS <br /> V :lir h+ S S. isSire' C.A <br /> 1 0 5 u�n �. a � 'Ko Hh <br /> DDr cLu rk � No <br /> Riq S, iz cit <br /> -c <br /> 'LIJ264a4fCA <br /> ENVIRONMENTAL HEALTH DIVISION FILES Los Ue�fSl�, ` <br /> X5 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSWG ABATEMENT Ig SOLID WASTE FACNJJ�TI H1t`110 <br /> E OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY 0 SOLM WASTE VE LLL777611777 L� <br /> ,M UNDERGROUND TANK(MONRORINWREMOVAL) o DOG KENNEL O DAIRY <br /> 2� HAZARDOUS WASTE 43ENF-QATOR 0 CHICKEN RANCH X PKG TREATMENT PLANT <br /> ❑ TIERED PERhUrrED FACIUTY 0 MOTE1JI0TEL 0 PUMPER TRUCKFYAFVCNFMT <br /> CF TATTOO/BODY PEJRCDJ6 11 POOLISPA 0 LAND USE APPLICATION SITES' 2 6 2000 <br /> G MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM Cl OTHER[PLEASE SPECIFY ABOVE) <br /> I. List up to ten addresses in the space above. Select the type(s)of fileb from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 464-0132 at,mail to the <br /> address indicated above. <br /> 2• EHD will notify the applicant if any EHD tiles 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 /> 31 A file that is actively being worked on by EHD staff may not ho immediately available for review- A now <br /> application may he suhneitted 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$78.00 deposit prior to review. <br /> 5. 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3.00 pm will be processad the next business day. <br /> 1— ry� <br /> ^5`,z`y vNf"'I'r7�`. EyG2S�M'hS� :. +,it.yn-� > �Cre`c ♦ } - A. � � ;h_Snd <br /> RF,1!IEIM1lIrD, �`: 't,' ""`,>;'E$'� . Nr��S��r? ` 4}s.+^�1'b REVfEW p m`p. a-'.wry V�"'�sx �v/'�`•;f�n� f�•�yN �.. <br /> e,mff <br />