Laserfiche WebLink
6/2005 09:56 FAX 209 9480E cnv`yU002/002 <br /> �DaTEREC�IEIVED frll SAN JOAL`(QUCOUNTY <br /> "E L��\\II �� ENVIRONMENTAL 304�b AvHEALTH <br /> DEPARTMENT <br /> PARTrL CA ENT <br /> 05 <br /> 7OW09) 468-3420 Fax: (209) 464-0138 Web: www.co.SaD-joaqu!n.caus/ebLd l &3q7 <br /> ENVIRONMENT HEALTH PUBLIC RECOUS RELEASE APPLICATION <br /> ]z Kn �.Stt!,S eUSINESSIAGENCY: <br /> APPLICANT:_�� --� •1_ <br /> ADDRESS: a•Ll�—t+4'—�."l.�f I[ �7 \\ <br /> PHONE: FACSIMILE:('AR) <br /> TENTATIVE-APPOINTMENT DATE:_ Timer <br /> (please allaw 10 businass days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-S93,Oe FEE-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE %W–PT— <br /> UNIT <br /> \ PILE ADORESS <br /> vl tST1111111111 111,"1"1111 a L] Unit 1 <br /> I, sv y f. t� i <br /> LL51 z area 140,40 945t a �(}$ <br /> UST- s. suns t e a " U R2 <br /> �1�IUS .. Sean I o s <br /> {It�dj 1 u5T s, sree - a " Unita <br /> UST e�'siae Arl v«� a e - <br /> r1 LJ ,Les �. s vu e <br /> — 0 20 unit <br /> CAY <br /> vS Unit 5 <br /> r• si.m o0 de. v-c <br /> �\tn i sem, i a Rxr.� c ❑ <br /> amu' i ,NS1, m. sem rt mob CRY <br /> 2bk�C � mit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK NST))CLEANUP SITE(LOP) Ell 0 HOUSING ABATEMENT 0 SOLID WASTE VEHIICCLELE <br /> OTHER CLEANUP SITE(NON1LI 13 FOOD FACILITY SOLID WASTE VEH <br /> I& UNDERGROUND TANK IMONITORINGIREMOVAL) 0 OO'G KENNEL M DAIRY <br /> AS HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH I9L PKG TREATMENT PLANT <br /> 0 TIERED PERMnTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBOOV PIERCING ❑ POI 1R LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)----------� Z <br /> List up to ten addresses in the space above- Select the type(s) of files 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 rive business days but no later than ten (10) days after receipt of application. The files <br /> will be held for it 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 ne` <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will he reorganized by EHD staff at the experts <br /> of the applicant Future rile reviews by the same applicant may require a $93.00 deposit prior to revie <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nextbusiness day, <br /> ;�'CONFIRMF-DI, , NT'dATE: .... , � . <br /> .TIME <br /> rPHONE - ;",:_•" fiuf'I"A <br /> LFAXDATE CONFIRMED <br /> - - <br /> REVIEWED YES NO REVIEW DATE <br />