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x" 11/02/2004 10:04 91686104"' Allift SECOR PAGE 02/0 <br /> / 01/2004 15:10 464013 EFNIP,ONMErITAI HES_ ,I PAGE 01 <br /> DATE RECEIVED ZI-V LOG NUM6EP <br /> AN JOAQUIN COUNTY <br /> J IJ NVIRONM ErNTA.L HEALTH I)EPARTMNT <br /> 304 F Weber Ave 3`a Floor Stocktou,CA 45205 <br /> NOV 0 2 20x409)469-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caw-,/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIGWT: Q 1'1 NU8INESS/ACEHCY: SQ�UYr 1+n 4�✓}7CA4� <br /> ADDRESSrp,J/al�7Q i I r O �CI • <br /> PHONE:( 1L(Y� -Gq L)o --FACSIMILE: (0)10 p CAs 0 <br /> 1"1=NtA11VE"APPOINTMENT DATE: <br /> Vy <br /> (F'IoaA Show 10 business days from date of application subm" <br /> 1 CHECK BOX TO EXPEPM REgUIEST-$93.00 FEE-REQUEST PROCESSED W 3 8USff4ESS DAYS <br /> SIGNATUkT OF APPLICANT DATE <br /> �rt Declsartrrtent Use Orth/ <br /> FILE/sDalt>SS UNIT <br /> P Ultit z <br /> 4. sree� PC• a /T V� '� <br /> 6 / L Unit 3 <br /> a_ s�,eel -? 1� lL 5•f0 �t7►-� C <br /> t. sarw tJ l7 G C' 7 C1. 5 �ee 4 <br /> '4 <br /> Unit 5 <br /> 8. Street <br /> SO 1 L 1✓i v! Q c. <br /> �o. �D L�yr(' ✓1 ,�+oe S }�� ,,, r,r�r f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> S711-1 11� <br /> ❑ HOUSING/►SA'CCNIENT t3 sot.ID WASTE FACILrry LL I <br /> 1�umERGROUND TANK(UST)CL-MUP SITE("r) 0FOOD FAC1LrTY ❑ SOUD WASTE Y'EHICLE <br /> D OrAER CLEANUP SITE(NON4_OP) <br /> tlNDERGFCOUNU YANK(1�oNrri3fUNG/REM(WAL) Q WG KENNEL O �X C � L <br /> ?r HAZARDOUS WASTE GENERATOR ❑ CHICKEN PANCH ❑ PKG TREATMENT PLANT <br /> C3 TIERED PERMIi7Eb FAG�m 0 MOTEIJHOTEL Q PUMPER ZRUCK/YA"CHEM TOR- y <br /> O TIERED ERMIODY 1ED V 1YG ❑ POOL/SPA $LAND USE APPLrATtON SITES <br /> 0 MEDICAL WASTE PIER <br /> C4iG o aTHER(nme sptol ) <br /> fr*m the checking <br /> 1, List up to bases In <br /> leastone8b type MUSTelect tbe he sesectevi f Faxst 2d914I -0138 a� <br /> the appropriatebox(es). <br /> addressI d e a P a appointment for reel®w will be conSrmed <br /> 2. EHD will notify thea pllb (jo)days ant if any EHD files exist An after receipt of slpplicatlon. The files <br /> approximately five business days but no later than ten(10) <br /> will be held for a maximum of five business days for roview. Appointments should be scheduled <br /> accordingly. <br /> ply being worked on by EHD staff may not be immediately available for review. Anew <br /> 3. A file that IS activ <br /> trpplication may be submitted when the file Is available. <br /> 4. Any fife not returned the revi0ews by the same applicanwill <br /> t may require a$93.00 Ideposi prior to review <br /> of the applicant <br /> *TENTATIVE Appointment dates must be confirmed with EHO staff. <br /> g. Applications received after 3:00 pm will be processed the next business day- <br /> 'CS!NF1F'tM�a.AP061N'tMENT DATE 1 .;..., <br /> i R�` `�PHdNEFAx••. t&fAWSI <br /> fZtMEWED <br /> YES HQ REVIEW DATE. <br /> - rHo ae-0ZovR <br />