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04/06/2005 09:56 FAX 209 9421 . U 002/002 <br /> DATE RECEIVED <br /> (� �� <br /> SAN.1oAQUfiY CouNCOUNTYW EDD W� DDD ENYIRONiY1ENTAL$EALTH DEPARTMENT <br /> 304 E Weber Ave 3b Floor StacktorL CA 95205 7 <br /> k.PR - 6 7000109) 468-3420 Fax: (209) 464-0138 Web: www.co.=-joaquia.c&us/ehd I <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> u� n <br /> APPLICANT: 7L�.1 UV 51�t3 BUSINESSIAGENCY: /�11'lt LCC <br /> ADDRESS: <br /> PHONE: (a�',� 1't9s FACSIMILE: <br /> tojd) ggy-orej <br /> -M <br /> TENTATIVE'APPOINTMENT DATE: ��„ Tlme: Lc? Cn - <br /> (Please allow 10 husira0.99 days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$97.00 FEE-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Tr' aj!5 DATE YQ <br /> Departrnent Use 0* <br /> PILE ADDRESS UNIT <br /> i, arxr f. W i a oZ L3 Unit 1 <br /> 2 Sims �fG a N <br /> O " 'g Unit 2 N-1 LI.-.0\5 <br /> •, sww31%a. Aciulmf� City <br /> S. sr ,_ v�,:_; _ a k.. Unit 3 <br /> C. alfael Fr) a., 6 � 3 a <br /> r. sv�e -Ov c r " unit <br /> r, sum ob dc- v-e 'I <br /> s. <br /> sumoilu fst A0,60r, ReJ Ott Unit 5 <br /> Io. sum <br /> M11M,ed, CRY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X <br /> UNDERGROUND TANK NST)CLEANUP SITE(IAP) Cl HOUSING ABATEMENT 9L sOUO wAsTE FAGILrrY <br /> OTHER CLEANUP SITE(NON{OP) ❑ FOOD FACILITY ❑ SOUO WASTE VEHICLE <br /> MP UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL BL DAIRY <br /> ffi HAZARDOUS WASTE GENERATOR P CHICKEN RANCH 19L PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOomooY PIERCING ❑ POOLISPA 5L LAPID USE APPUCATION SITES <br /> ❑ MEOICAL WASTE FACILITY ❑ OTHPR(PLEASE 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 (209)464-0138 or mail to the <br /> address-indicated above- <br /> 2. EHO will notify the applicant it any EHD files exist. An appointment for review will be confirmed <br /> approximately rive 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 review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked an by EHD staff may not be immediately available for review. A ne, <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expens <br /> of the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to revie <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nextbusiness day. <br /> .Z'—C F4 RM D APFOINTINENT'.dATE x..' <br /> :%>T:�}s„ TIME <br /> DATE CONFIRMED 'PHONE FAX' ` %INITIS <br /> REVIE)NED YES NO - REVIEW DATE <br />