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01/28/2002 13:29 2094671" AGE STOCKTGN - r'Hu� Lj,/-;u2 <br /> We MCEIVEDEHD LOG NUMBER <br /> JOQUIN COUIiiTYPUBLIC HEALTH SETT-0JICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEB ER AVENUE,THIRD ps".;' /Z/ <br /> STO KION CA 95202 ,..,, <br /> ( 09)468-3420 <br /> p2 PUBLIC RECORD 3 RELEASE APPLICATION <br /> APPLICANT BUSIN SS/AGENCY UD I <br /> ADDRESS Uj 6 <br /> PHO D4 FACS1ILE <br /> ENTATIVE*APPOINTMENT DATE TIME h <br /> (Please give 7 to 10 busine days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$7 0 FEE—RE9 EST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z g OZ <br /> FI E ADDRESS <br /> d i <br /> Vt win <br /> 3Sz <br /> 3S 21'1 ML Sa <br /> S SS <br /> tA <br /> 3s�a-S� <br /> y8 <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT Q SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DO KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHI KEN RANCH ❑ PKG TREATMENT PLANT <br /> 11ERED PERMITTED FACILITY O MO LIHOTEL © PUMPER TRUCKIYARDICHEM•TOIL.ETS <br /> 4 TATTOOIBODY PEIRCING O P LISPA © LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ Py iLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abo e. Select the type($) of files-from the list above by checking <br /> the appropriate box(es). At least one file pe MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business days but no ater than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is.actively being-worked on by HD staff may not be immediately available for review. A new <br /> application may be submitted when the fi a is available. <br /> 4. Any file not returned In the same conditioi as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be onflrmed with EHD staff, <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Eli 00 14 01105/00 - <br /> 0 <br />