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!3JU6 66005 STRATUS NO CALIF <br /> PAGE 01/01 <br /> 05.!11/2004 14;50 4640196 , ENVIRONMENTAL HEAL rH�t of <br /> DATE RECEIVED _ I,, Icrvu w�Numocrt <br /> S IF)' SAN JOAQUIN COUNTY <br /> ( <br /> � L� �� <br /> fo i�U �NwRONMENTAL HEALTH DE+PARTMENT <br /> //(n�((��� 304 E Weller Ave 3`1 Ft...Stocictoz>, CA 95205, <br /> 5205 <br /> \pf (20§)`x$-3420 Fax: (209) 464-0138 Web: www.0O3san-joaqu1n.cau5lehd <br /> HE-ACTH <br /> „9�1JTISI 1}JICERUBLIC RECORDS RELEASEE APPLICATIONS q <br /> APPLICANT;/S�G6M� �BgI��111'�/I EUS1NF39/AGENCCY:,ST 5 huiron <br /> ADDRESS'�.'12� 1/C.�^IYIt81O[r�1��P Q,- :'5lu ``I/nCra1C{•��/-�/T <br /> HONE: ],.0 LIQ i�'�---7_� -,J—FACSIMILE: <br /> TENTATIVE*APPOINTMEN7DATE: <br /> Llo� <br /> (Plazsoallow 106usinassdeystmmdate ofapplication submltlal) e4'hb' fivHy15 <br /> lelw (ef rhf kKa✓). <br /> In CHECK BOxTO ExPEorrE REQULS"T-$53,000 5FE-.REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 510;NATURE OF APPLICANT ✓ �t" Z DATE Z31J <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 9 Fast i unit 1 <br /> z. strer. 7 !J <br /> a. 9raa a, D Unit <br /> 4. G <br /> e, stem ar ❑ Unit 3 <br /> 5. SIWE G <br /> r szK t G Unit <br /> e_ <br /> GN. unit 5 <br /> 9 -strcei [� <br /> G <br /> to. steer <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILED <br /> UNDERGROUND TANK(UST)CLEANUP 317E(LOP) ❑ HOUSING ABATEMENTj <br /> SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) FOOD FAGtLnY SOLID WASTE VENICE]= <br /> ❑ UNDER®ROUND TANK(MONITORINGIREMOVAL) d DOG KENNEL DAIRY <br /> ❑ HA7ARDOU5 WASTE GENERATOR M CHICKEN RANCH PKG TREATME PL4NTP TIERED PERMITTED FACILITY 0 MOTEtJHOTEL PUMPERTRUCKIYAR0ICHEM TOILETS <br /> ❑ TATTOOBODY PIERCING M POOUSPA LMO USE APPLICATION SITES <br /> MEDICAL WASTE FAFlLttY ❑ OTHER(PLEASG SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the <br /> address indicated above• <br /> 2. EMD will notify the apiengant if any EHD files exist- An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for Tevlew. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for rev w. A new <br /> application may be submitted when the file is available.d will be reorganized by EHD staff at the expense <br /> 4, Any file not returned in the same condition as release <br /> of the applicant. Future fila review's by the same applicant may require a 593A0 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRME13 APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE , FAX INITIALS <br /> REVIEWED - YES NO REVIEW DATE <br /> EC01 B, <br /> enaooe <br />