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Oct 25 04 03: 49p p. 1 <br /> 10125/2004 16:09 46491• ENVIRDNMENTAL HEAL PAGE 01 <br /> I: <br /> WE RECEMM- EHD LOG NUMDER <br /> SAN JOAQWN COM'Y <br /> OCT 2 5 2004 ENvmoNmENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 34 Floor Stockton,CA 95205 <br /> ENV!11L{,, 1-iEALJ�D9)468-3420 Fax: (209)46"138 Web:www.co.san-joaquin.ca.uslehd Z090 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APP[1CAtfr: `� rz.l-t F"1J Q-7 BUSUYi=SSIAGENCY' ti 'n TAX <br /> ADDRESS_ I CA ,5�O� ,:� �.+ r...� -I q'(0 <br /> PHONE! �CSv' r7" g 3 1ACSILE MO .MA <br /> TOWATM-APPOWMENT DATE. <br /> (P omm allow ra bu-in ns days am,d *of aponiatlan wba"A <br /> CHECK BOX TO EXPEDITE REQUEST-MAO FEE-REQUEST PftOCES5E0 04 7 BUSINESS DAYS ,S,ios. <br /> $10HATURE OF APPLICANT <br /> �G�--�i ✓--� DATE t 0 � 4� <br /> Departrnent UN Only <br /> i rk-, ir,, t tbrf. a-A•-fz <br /> FRE ADDRESS EIt�fT <br /> a�y <br /> z : <br /> 3ci� 0 <br /> Unit 4 <br /> ._ ani ❑ unit 5 <br /> ENVIROIVIAI_N'f'Al.HEALTIi DEPARTMENT FILES <br /> VROMROUNo TANK MT)ctuAMM SaE ROP) 0 HOUSING ABATEMENT �—`$iM- WASTE FAGumr l\ <br /> HER CLEANUP SITE"ADM d Fp00 FACILITY o D�WASTE 1/lrtflCLE <br /> _UNDERGROUND YANK P1OWI`ORlMGfRl:ll�aVAL) 0 DOG KEWEL E3 DARYR�EATMENT PUNT <br /> 0 -MRHAZARDOUS WA3TE GEMCMTOR 0 CHICKEN RAl11CN la PMpm TRUCKIYAROMMM TO�EM <br /> REa PERatrlTm FACILITY 0 MOTESlh10TEI. <br /> ED MODYPERMI PIERCIIV� 0 POOUSPA LANs USE APPLICATION SfTF,i 1r <br /> 0 UrDICAL WASTE FAGILrrY f7 OTHER(PLEASE SFECMYj <br /> 1. Ust up to ten oddresses In the space above. Select the type(s)of flies front the list above by cFlecking (` <br /> the appropriate box(es). At least one file type MUST be selected. Fax to{x091164.0138 or mail to the L• <br /> address i ted above. <br /> 2 EHD wlil notify the applicant If any FFD files exltt. An appointment fa'rev+aw will be confirmed <br /> approximately five business days but no later than ton(f 0)days after recelpt of application. The riles <br /> wl8 be fseld for s maxlmum of fire-business clays Ser review. Alppoit>tmeats should be scheduled. <br /> accordingly. <br /> 3. A file that Is actively being worked on by EtiD staff may not be immediately available for review. new <br /> application may be submitted when the file is available_ sized b EtfD staff at the expanse . <br /> 4. Any file not retumed in the same condition as released will be reorga Y <br /> of the appliosltt. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> �$. 'TENTATME appokAment dates must be confirmed with 12:1-11)staff. <br /> g• Appilcatlons received after 3.00 pro will be processed the next business day. <br /> a[ 0r1 41IM413 �POIHl1AEW DATE �'w- - <br /> '`" FAX-: <br /> I�AT$CDNf1RNtE1)~ ,�• .,:�• .. , • .. <br /> *tVIEWED . ,_ 'YES Is10 REVMW DATE. - <br /> �o <br /> rnv�i <br />