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f <br /> 09/i6/2005 13:30 209472K- ' PAGE 02/02 <br /> s it �D E7 <br /> 4640138 " WIROhMENTAL HEMALTr;, PAGE 02 <br /> � Swo�aG nv�aFn <br /> SAN JOAQUIN COUNT'YPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P 1 6 2005 " 304 EAST WEBER AVENUFl oHIIRD 1=1.00R ; <br /> '€ IrNEf1R0*Af.NT I]EALTH STQGKTON CA <br /> (209)408-3420 <br /> PEHf:? T! Ff�VlCl S , PUBLIC RECORDS RELF-ASS APPLICATION <br /> DustltEssfAOI.`=NClr �1 � env l.rc'CS!nVl� <br /> 'j ADDRESS <br /> PHONE 7:. .D —FACSSIMILE ` <br /> T£NTATWApPO =QATt= E <br /> � - <br /> AaLL <br /> (Real*ON*T to 10 tnrsltsesa&A from data of appl valJon submittal) <br /> i <br /> GIisECK B0X TO exPmrrE REQues'r- 89.00 -R CES w W 3 BUSINESS DAYS <br /> .5 <br /> i <br /> �SIGNATURl~OF APIICAHT <br /> PLLE AO S 7fiIS 8I(7E ENP STAFF M MLY <br /> CO <br /> PROGRAM ELME BF,AKGH <br /> i <br /> ENVIRONMENTAL HEALTH D VISION FILES <br /> WA <br /> ROVNO TAMC Mn CLEANUP SITE(Lfm b HOUSING ABATEMENT ❑ SOLID WASTE fACrLl7Y <br /> UNgERG <br /> R MNUP SITE",LOP) G MOD FACWTY D SOLID STE VEHICLE <br /> `' YTI#NEDPIZIEEORQQGP1R�EO0RU4IigHYTD PTTEEAIDfMtGFmCA�C413rI C)t}YfYITORiKGRENYA <br /> Ll G CH! I 3 DAIRY <br /> O CHClMPl RANCH pKr.TREATMENT <br /> PLANT <br /> CI 0 VMTFtUCKfWAPM1CH <br /> EM Y <br /> DiLT <br /> Q 0 MOTWJKdTELQ LPSD USE <br /> t9 0 POOIJWA O 0,MFR(PiEASESPECIFYABOlE) <br /> 4 Ip;[FCA.WASTE FAGrLITY -6 0.PUBLIC WATM SYSTEM <br /> he <br /> from <br /> ist above <br /> 4. List up to tett addresses in the aps�ce above MUS MUST selected{roles <br /> 349 4 itr4�'129 orbena <br /> the appropriate box(" At!t=at one file type <br /> ss' ap <br /> An appointment for WOW will tm con <br /> 2. EMD will notify flee ap lint if any EHD files exist. firmed <br /> appraairrtately free buklness days but no later than ten(10)days aft t���Pt should of he scl+edThd fll(as <br /> will be held for a maximum of five buMn£Ss days for t�eView►. Appointments <br /> . 2ccorilingly, <br /> . A fide that'sS serve <br /> belr+g wo&Gd On by EMD staff may not by irnmedlately avallalzle for re,rlewr. Anew <br /> applientlen may de SUbmittad when the file's"*liable, <br /> by 4. Any file not returned in the some condition as relewso c nit may r@q rIl a X34.00 de pvs pll be marPzed rior to staff at th* evitw. i <br /> of the applicant Putuet file reviews by Me s2tne app <br /> 5, 'TI:NCA�Appointmortt dates must by confirmed with iio stalff. <br /> C. Application,renewed a4ter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE_ <br /> TWE <br /> '# ( QATE CONFIRMEDPHONE FAX -INITIALS <br /> REVtEWI=D YES NO FtEV1EW t3AT1= i <br /> 3 <br /> 1 <br />