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12/69/2004 09:49 FAX 9162905429 FKA*ENVIRONMENTAL [31002/002 <br /> 1l:UU 409tl Jtl ENVIRONMENTAL HE N PAGE 01 <br /> iLi UI/LUU4 � � �� <br /> LOG MJMBER <br /> pA'IE RECEWED � � �. <br /> ( SAN JOA�QUIN COUNTY <br /> ENVIRONm:ENTAL]IEAL'I-a DEPARTMENT <br /> 304 E Weber Ave 3"°Floor 5tocktoa CA 9520 <br /> (209)468-3420 Fax; (209)464-0138 Web:WvrW.Co.san joaquin_ca us/ehd <br /> pUI3LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MA++""' l y l'r BUSINE33lAGFJLCY: <br /> ItJGll,ae -.K�i1 ¢ Asreo:� Ie! <br /> ) g)IrD / w��i sr.GM•-4. CES qs�v <br /> ADDRESS: 3 0.5 0 �,..(v r f'�'I c 9 /(, - 2 90 - S4 2-9 <br /> PHONG: 9 /4 - 3 ?t2- /41 ,?'/ FACSWMX: <br /> „ yer l� 2cr"I 7: 3 D <br /> TENTApoiN MENT DATL: DC G G Tkne: <br /> (Please alloy 10 twslness days Mom date of epPucaUon subn%MA <br /> A�V r SED <br /> CHECK BOX To E)PEDRE REQUEST.$93.00 <br /> REQUEST! OCE33EP pLDA DATE lZ /8 I�7 <br /> 4i <br /> SIGNATURE�I APPLICANTp gUaeO+N <br /> UNIT <br /> `rt.t1eweuu �/ Osov l 1.W Lfneel✓FILL JADDRESS F TocK r� ° <br /> .;' unit 7 <br /> X Te_ Pa� <br /> r r_K" <br /> WeSeI A✓ 5 )4, 7- <br /> nit <br /> nit2-)--de�,; <br /> oc�r� <br /> > s AvG s <br /> 6, eaed O w We / ,1v[>z' rJ F sroCle7b✓ tom{ Unit <br /> 6 W We be- A✓t` �1�; STo <br /> 6 KTu-� by <br /> 6. W e- — /LVLT IJ 1 SToCX7,0 •/ _ 84 <br /> �(O 26 STocK.fs� <br /> y a s�L A N J3 S T c fi r o <br /> s. cvK+ f1 PN /3 2 6 0. n_ 0. Yrt <br /> U r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FI <br /> ❑ HOUSING p$A7EME ❑ SO <br /> N1 13 SDUD WASTE PAODJTY <br /> UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) LID WAST[VEHICLE _ <br /> O FOOD FACIUTY ❑ DAIRY <br /> OTHER CLEANUP SRE(NOWOW ❑ DOG l�lEr- <br /> UNDERGROUNDTANKtMONITORINGLR1=rdOVAL1 13 PKG TRUC PLANT '•..,., <br /> El CHICKEN RANCH p PUMPER TRUCK/YARDr(7{EM TOLLE'TS <br /> OHA7j%pp0U$WASTE GENERATOR O MOTELMOSEI- <br /> TIERED PERMnTED FACILITY - - O POOLISPA ❑ LAND USE APPLICATION SnES <br /> 0 TATT0MdDY PlMc1NG C3 UM17R(PLEASE SPECIFY) <br /> Cl MEDICAL-WASTE FACUTY y checking <br /> 1 U;t up to ten addressesan the space above Select the type(s)of files from the list abo_a pY <br /> the appropriate box(es)."Meast one file type MUST be selected. Fa t to vie 4 ill be confirmed or mall to the <br /> address m9icatted above: Et{D files eX%t. An appointmeot!: r review rvNl blleailon�The files <br /> 2< EHD will ncrtay the applicant N arty 10 days after receipt of app <br /> approximately five business days but no later than ten( ) Y lritments should be scheduled <br /> Wtli be held for a maximum of five business days for review. APPo available for rOVIaW. A nM <br /> accordingly. <br /> 3• A file that is a be sueeing wd when the fife is wmllable.not be immediately <br /> apppcaGon to revie+ <br /> 4. Any filo not returned In the same condLbon as released wail be reor>��a�g$93 OOHa <br /> posit apriorthe <br /> e�ens' <br /> of the applleant lntmenfldates must be aonfirmed wllt�h EHD staff. <br /> a• °TF,NTATNE appo <br /> S Aprlica0ons received atter 3.00 pm will be processed the next busir,ass day. <br /> CNF1Rd�fEE3�pP(ylN�7ufkiTiT;DATE ;- <br /> A g,}IbNE FAX dtTCftAly$ �-r--f <br /> NO REVIEW DATE <br /> •_ : . <br /> P3ivYlE1N1=D YES - <br /> {6o1d 4 <br />