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r7Z <br /> ��� <br /> ANTE�iII��" E'--J SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES fiHO ll]G N111[BER <br /> OCT 4 ENVIRONMENTAL HEALTH DIVISION <br /> 2000 304 EAST WEBER AVENUE,THIRD FLOOR <br /> Sf OCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468.3420 <br /> PERMIT/SERVICES PUBLIG RECORDS RELEASE APPLICATION <br /> APPLICANT BVSiKESSIAGENCYr.�—� 1�i1t-WARP' �� • <br /> ADDRESS ZS Z5 I-• M Y 61�5Ed <br /> PHQN>r Z FAcsimiu- d�ZF <br /> TENTATIVE"APPOINTMENT DATE O,ll-2000 TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- FE — ERU ST OCF_S DIN 3 BUSIN1=SS DAYS <br /> SIGNATURE OF APPLICANT �f rl DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> G <br /> ` , PRORAM ELEMENTS SEARCH <br /> �O �4Ct�CAve. — A 1� <br /> 4 t0 i4e, AVC — All _14,n,+s <br /> -767 <br /> .1140 U1, sR11tlLI` L�►#G 3: Cr I��C <br /> p Lawt,' $Ct,ara+aaA•�D 3.�•��-(: G[� <br /> 4to 0.G G Ave, <br /> 7444- c e- <br /> mr Ile <br /> - <br /> +7$5 trF►c ,4v�• l <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> jiC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT or SOLID WASTE FACILITY <br /> 8I OTHER CLEANUP SITE(KON-LDP) fO FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> V UNDERGROUND TANK(MoKrrORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> QIr HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL 0 PUMPER TRUCKIYAROICHEM TQIL€T3 <br /> 0 TATTOOMODY PEIRCING E3 POOLISPA ' Cl LAND use APPLICATION SITES <br /> .0 MEDICALWASTI=PACII..ITY Cl PUBLIC WATER SYSTEM C OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax (2p914S4.0138 or mato the <br /> address indicate bove- <br /> 2. F-HD will notify the applicant if any EHD files exist. An appointment for review will be Confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should bo scheduled <br /> accordingly. <br /> 3" A file that is actively being worked on by IEHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is avallabie. <br /> 4. Any file not returned in the same condition a$released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm will be ptor*ssed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> UK <br /> Inn F3i _ r7nn exo nn� ,.c;.s nn•... ...... .... .z,. ...� <br />