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0ciTJ3/2005 15:17 FAX 209 948069' Z002/002 <br /> �(� Elf� SAN Q cnv�,� <br /> � �j` JoA trlri COUNTY <br /> fi ENVIRC)nIENTAL IE[EALTR I)EPARTIYLENT <br /> P F� 1) 9095 304 E Weber Ave 3`' Floor Stockton,CA 95205 <br /> USNIRONMENT HPPIA 468-3420 Fai". (209) 464-0138 Web;WWW.co.san joaquia.c0-U5/ehd <br /> PE<<,' 1T/ ,rP',''Ir S PUBLIC RECORDS RELEASE APPLZCAT' N <br /> APPLICANT: i !�� �?(bS�.� _ BUSINESSIAGENCY: e;t <br /> ADDRESS: �.S i� 1�1 4 S _ v c A5. <br /> PHONE: flxpl 149- X1415-, FACSIMILE: _ azqj 1-ty vG2, <br /> TENTATIVE'APPOINTMENT PATE:--(Flo nnw: 1 <br /> (Please allow 10 business days from date of application suhrnttml) <br /> CHECK BOX TO EXPEDITI=REQUEST-593.09 FEE-REQUEST PROCESSED M 3 9USINESS DAYS <br /> SIGNATURE OF APPLICANT AV7 IE <br /> DDevartrnent Use Only <br /> \/ FILE ADDRESS City <br /> I <br /> V' �\ a ��► ❑ Unit 1 <br /> '\r c I <br /> QaC, , <br /> ,. s--f lYt a ;S} 1 <br /> I IU,1 S. sued Ory O�XUnik 3 I <br /> � <br /> SIS7. s tMy <br /> - <br /> 'f w a 4 <br /> aty <br /> Saco city )) ❑ Unit 5 <br /> �o. sand 4, <br /> • ,.yr <br /> ENVIRONMENTAL MEAI._TH DEPARTMENT FILES A100i) <br /> 9 UNDERGROUND TANK(UST)CLEMUP SITE(LOP) ❑ HOUSING ABATEMENT NL SOLID WASTE FACILfTY <br /> f OTHER CLFANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE r! <br /> UNDERGROUND TANK(MONITORIDIGIREMOVAL) ❑ OOG KENNEL DAIRY <br /> 0 yuA7 D6US WASTE GENERATOR ❑ CHICKEN RANCH 2L PKG TREAT1 F-K—r PLANE <br /> O TIERED P1 KNITTED FACILITY ❑ MOTELIHOTEL ❑ PUMtv <br /> PERTRUcYARDICHt-MTOILETS 7 5r) <br /> C, PDOtISPA M LAND USE APPLICATION S i-ES <br /> El TAT7oO/80DY PIERCING : <br /> ❑ MEDICAL WASTE FACIL.ITY d OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above., <br /> 2. EHD 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 net <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie' <br /> S. ''TENTATIVE appointment dates must be confirmed with EHD staff. <br /> C. Applications received after 3:00 pm will be processed the next business day. <br /> Q TIME <br /> �C NF�RM D;APPOINTM.ENTbA.E _= -';r <br /> FAX lNl"GI <br /> pAT1;CONIFZMEQ — - .PHONE - :r ALS <br /> _ ' '� <br /> REVIEWED YES NO REVIEWDATE; ' '... <br /> • c.+n n.ei-noa . <br />