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04/04/2000 16:05 6509525325 RAKESH PAGE 01 <br /> � uNu <br /> 07SAN JQAQUIN COUNTYPUCLIC HEALTH SERVICES � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3041;AST STOCKr0N CSA 9 202 THIRD FLOOR <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION OCT 002 <br /> ' QK� 1t��r BUSIHESSIJIGENCY �-�`-I?J� k�dVlR�ip1M€WET HEALTH <br /> APPLICANT a <br /> AdDt:ass dl -roh 'q-T �� �pl>K4 fS6` RMIT/SERVICES. , <br /> P110N 5-'6 CC,6— 2-6 FA�1MILE: Z5 �11 ( - �-6 6 <br /> TENTATIVE"APPOINTMENT DATE TIME , <br /> (Pic give 10 b Hess d ;a to of aVPIUSlen submittal) <br /> CHECK 4oX TO EXPEDITE REQUEST-�p9.o0 FE R6 -ST 110 I1NE5S PAYS <br /> SIGNATURE OF AppLICANT <br /> bAT5 l d — <br /> PILE AODRE88 THIS SIDE PID STAFF USE ONLY <br /> PROGRAM ELEMENTS$PARCH <br /> • ��r ENVIRONMENTAL HEALTH DIVISION FILES <br /> B=OER <br /> ERGROUND TANK(UST)CLEANUP srrt(LOP) Q HOUSING ABATEMENT . ❑ SOLID WASTE FACILITY <br /> CLEANUP SITE(NON•LOP) �FQQD FACILITY ❑ SOU[)rVASlE VEiHIGLE <br /> UNDEAGRoij Jo TANK(MONIVORING(Ei1;MDVAt,} 0 tlgG KEHNFJ. 0 DAIRY <br /> 13 CHICKEN RANCH ❑ PKG TREATTKENT PLANT <br /> HAZA►tDOUS WASTH GEiNbRATOR ❑ MOTELlHOTBL n PUMPER TRUCWYARDICHrM TOILETS <br /> ❑ TICRED PERMITTEO FACILM ❑ POOUSPA 0 LAND U315 APPLICATION SRt fi. <br /> ❑ TAYTOOIOODY POPCINCrp PUBLIC,WATER SYSTEM 0 OTHER(PLEA5E SPECIFY ABOVE) <br /> ❑ MEWAS'T' <br /> DICAL E FACILITY s <br /> 1. List up to ten addresses in the space abovo. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file typo MUST bo selected. Fax to(� 0 -018 or mall ko the <br /> ddress Indicated abovo. ' <br /> 21 EHD will notify the applicant Han y EHD filen exist. An appointment for IrQviow will bi Confirmed <br /> approximately five business days but no later than ton(10)days after Tocelp!of applicatipn. The flies <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file lhat.is actively being worKetl on by EHD staff may not be immediately evallable for review. A now <br /> appllcailon may be 6ubmittad when the file Is available. <br /> 4. Any file not returned lh the same condition as released will be reorganized by EHO star(at the expense <br /> of the applicant. Future file reviews by the sarho applicant may require a$89.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> G. Applications race)ved after 3,00 pm will be processed the next business day, <br /> I <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> m n,T�7—"•r" <br /> TO 39bd H1-Id31­1 -1t11.N3WNCZ1AN3 8EZet9v LL:60 Z00Z/TT/0T <br />