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AUG. -11' 04(TUE) 14:08 -VERSAR, INC. TE1;9169622678 P., 001 <br /> 4n, A �- mSAN JOAQUIN COtTNTy Otto Loi NUMeeR <br /> F-WMONMENTAL HEALfiH DEPARTMENT <br /> AUG 7 2004 304 F Weber Ave 3rd Floor Stock--ton,CA 95205 <br /> HEALTR09)468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.ca.tis/efid <br /> F ;: ,;r,.riS VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:T1�}I.l I Gory-11 <br /> fEBLISINESSIAGENCY: <br /> ADDRESS: � <br /> PHONE S FACSIMILE: Ce <br /> TENTATIVE'APPOINTMENT DATE:%A0nejr1\j Q ?1 aLLtTIma: 10040 <br /> (Please allow Io bualness days from data of appllcattan submhtai) <br /> CHECK BOX TO EXPEDITE REQUEST-$03.00 FOR-REQUEST PROCESSED IN 8 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1511-7 O <br /> Peoaamani Use Only <br /> LE APORESS UNIT <br /> a A U 5T �� a Unit 1 <br /> a. s & <br /> ,���c(:�l Slreel r �' /1 C a �5 Q t�Rlt 2 <br /> s sh& CRY Unit 3 <br /> a. Street Ch - <br /> I <br /> 61meC Coy Un <br /> Sites! <br /> CDV <br /> g s Q Unit 5 <br /> 8lreal -.G <br /> AMNENVIRONMENTAL HEALTH DPPARTMENT FILES ,� <br /> qet UNDERGROUND TANK(UST)CLEANUP SITE(LOPi 0 HOUSINQ ARATEMENT M SOLID W ACI <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY M SOLID WASTE vF-HICLE <br /> IRI�UNDERGROUND TANK(MONITORING(REMOVAt) ❑ DOG KENNEL A DAIRY <br /> 91'HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> o TIERED PERMITTED FACILITY M MOTELIHOTOI. C1 PuMPI=R TRUCKIYARDICHEN TOILETS <br /> 0 TATTGOBODY PIERCING ❑ POOVSPA ❑ UWD USE APPLICATION SITES <br /> 0 MEDICAL"WASTE FACILITY IO OTHER IPLEASE SPECIFY <br /> 1. List up to tan addresses In the space above.'Salect the type(s)of files from the list above by checking <br /> the appropriate box(es). At least ona file type MUST be selected. Fax to Izo91464-0138 or mall to o <br /> 2. EMP will notify the applicant If any EHD files exist.m An appointment for review will be confirmed <br /> approximately five busIness days but no later than ten(10)days after receipt of application. 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 that Is actively being WOTked an by EHp staff may not be Immediately available for review. A new <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 Elio staff at the expanse <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVF.appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> Yd Maui <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 5HO 40A:404 <br />