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04/06/2005 09:56 FAX 209 9480 Z002/002 <br /> QATI;RECEIVED SAN JOAQULt-i COUNTY <br /> 91 C l 11'! ' 304 E Weber Ave, 31'� Floor Stockton, GA 95205 <br /> p.n;l — 6 ?I;�09) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ea>Lslekzd <br /> ENVRONI i H, LTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7z, x 5>� euSINESSIAGENCY; <br /> ADORESS: <br /> i FACSIMILE: <br /> PHQNV,. <br /> TENTATIVE'APPOI"F-NT PATE: Time: �a U <br /> (Please allow 10 husinBSS days from date of application submit L E COPY <br /> CHI=CK BOX TO E]CPEDITI^REQUEs7-59:1.06 FEE—FZECIUEST PROCESSED IN a BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF: APPLICANT _ - <br /> pepartrnent use On}v <br /> UNIT <br /> FILE ADDRESS <br /> Unit 1 <br /> W <br /> Z SVM 149140 ti <br /> Unit 2 <br /> 4, + I <br /> ++ AUnit 3 <br /> s. s n <br /> c ^ <br /> / ++ Unit 4 <br /> [( <br /> T. sem+ 17u C r <br /> fie- v-c <br /> '• S"`� °° 0 Unit 5 <br /> 9 Stree+ , 4 <br /> TZac� ,+ <br /> 10, Seca - rr t <br /> ENVIRONMENTAL HEALTH 15EPARTMEN I✓i S <br /> r -t `� / , sC)u0 WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE NOP) a HOUSING ABATF-MFNY 0 Sauu WASTM VEHICLE <br /> OTHER CLEANUP SIT>=(NON-Lop) LJ f Q, FACILITY <br /> ❑ I]OG FCENNEL 119- DAIRY <br /> EM <br /> a UNDERGROUND TANK(MONITORiNGlROVALI O CHICKEN RANCH LLQ.PKG TRI-ATME14T PLAT <br /> W RAZARDOUs WASTE GdENERATOR ❑ IiatOT�L ❑ PUMPERTRUcK-tYPKCs1GHEM TOILL7S <br /> CI TIF__R5D PERMITTED FACILITY z SPA M LAND USE APPLICATION SUr--S I X1,) gVS <br /> L] TATT041DOOY PIERCING p POOLPOOLIIOTHEt PPI E SPECIFY) `1 6/ <br /> a me0JCA-WASTE FAMLIF Y <br /> 1, List up to ten addresses in the space above- Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)4&.4-0139 or mai!to kh- <br /> address indicated above_ <br /> 2. EHD will notify the applicant if any END files exist_ M app aintmellt for reviet will blLcat on, The files <br /> approximately five business days but no later than ten (10) days after receipt of app <br /> mill be held for a maximum of five business days for review. Appointments should he scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by FHD staff may not be immediately available for review. A ne' <br /> application may be submitted when the file is available. aniz <br /> of the app ed b PHD staff at the experts <br /> 4. Any fila nlicantr Eutu a file reviews by the same appl'canretuned the same condition as released lt may require a $93.00 deposit prior to revle <br /> 5. 'TENTA PIE appointment dates must be confirmed with EHD staff. <br /> g. Applications received after.3:00 pm will be processed the nextbusiness day. <br /> h1TI4l1rNT �:.-. TIME <br /> /�'++ RM C].AF,PO! '.MATE. ��: ,,: _ :.;:�•:. <br /> . .; PlfOtsE FAX °INITIALS <br /> DATE; CONFlRM1=D <br /> REVIEWED YES NO RF-VIEW DATE <br />