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Jun 03 03 02: 01p Sarha_ra Moed (510) 1130-•0222 P. 1 <br /> JUN 0 3 2003 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPARTMENT <br /> i`••IPAENT HEALTH 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOC CON CA 98202 <br /> (,-Vg)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICIi,T OV <br /> APPLICANT ?3CLTk4L1/M MdeAA - t-r <br /> 6�USIN1<'SSlAGENCY <br /> ADDRESS yo2L Lt 4 Aye. - <br /> PHONE J�tQ 3 � Q��-. FACSM11L-> SPD <br /> TENTATIVE'APPOINTMENT DATA ( 13 I L w 41113 TIME <br /> (Please give 7 to 10 6ustmi s diys from date aF applicalion Sub 11It5.11) <br /> l�f3 _ <br /> GHECK BOX Tp rac,a>eDrrE RE sa9•ov <br /> FEE-• C1RIf5T PROCESSED IN 1 HUSIIIESS 0AV3 1/� , 14 ^ 4 <br /> SIGNATURE OF APPLICANT T DAVE _ �L <br /> n r THIS SINE EHv�l�rAl✓r`USE ONLY <br /> !A l O FILE ADD RESS IiROG I tAld CL.EI I E XTS Zt,IIRC <br /> (loft JE <br /> ENVIIRONMENTAL.HEALTH DIVISION RL1=S <br /> ■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0'HOUSING ABATFUENT 0 501.1n WA ITE F.M'tLIrf <br /> 0 OTHER CLEANUP 5RE(NON-LOP) CI FOOD FACUJTY CI SOLID WI9ITE VFJ*Veli <br /> ■ UNDERGROUND TANK(MONfrORINWREMOVAL) 0 DOS:KENNEL. 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANH O PKG TREK fME0t P?-AIIT <br /> 0 TICREDPERMITTED FACd_[YY 0 tAOnUJI40TEL 0 121)dPER7RUCKNARI V4EMTOILETS <br /> O TATTOOISOOY PEIRCING 13 P&WSPA O LANI)USE.APPLICATION SITES <br /> 0 MEDICAL WASTE FACILMY 13 071 MR(PLEASE SPECIFY) - <br /> 1. List up to tan addres5as in the space.above. 5electthe type(s)o7 files friam tt.-e list above by i:hecking <br /> the appropriate box(es). At least onn file type MUST be selected. Fax Io(209 ,d_„a,-0138 or mail to the <br /> address Indjcated stfove. <br /> 2. EHD will notify the appiltant-if any END Wes exist. An appointrnent for mvlea will be confirmed <br /> approximately five business days but no cater than ten(10)days after receipt )f application. The files <br /> will be held for a maximum of five btWna:;s days for review. Appointments sl tould be schadviled <br /> attordingly. <br /> 3. A fila that is Actively being worked an by END staff may not be 1"imed4b�ly ar.-allalbtn for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any iiia not returned in the same condition as released will be reorganiz(A bei EHP:Iteff at the expense <br /> of the applicant. Future file reviews by the same applicant may requirt a S89s10 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be i:onflrmed with EHD staff. <br /> 6. Applications mcelved after 3:00 pm will b r processed the next bLlsinerit :lay. <br /> CONFIRMED APPOINTMENT HATE TIME <br /> DATE CONFIRMED PHONE FAX tNrIIAL.s <br /> UR 1l=WED YES NO REVIEW DATF- <br /> IRW260 <br /> TO 39id Hl'Ri3H `1V'-LN3t/INWjAN:I 9E197'3P 6> :ISI F6©L!£Al9g <br />