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FROM : SIERRA WEST-BRIGGS+LAND PHONE NO. : 916 985 0786 20 2004 08:40PM P1 <br /> Oa/20/2004 -0:53 45400rg- ENVIROWENTAL HEAL',,, �,PAGE 31 <br /> SAN JOAQUIN COUNTY <br /> 1170) [1,uv, ILE-,La ENvIRONN, 1ENTAL HEALTH DEPARTMENT <br /> 304 1E Webe-z Ave 176 Flour StocktO�", CA 95203 <br /> AUG 2. 3 2�6)468.342o Fax! (209)464.013$ Web:v;%-w-co-san-joaquin.cauS/chd <br /> ENViRiNMENT HEALTH pUBLIC pXCORDS RELEASE APPLICATION -- <br /> �jp�p A U."4-k-1 <br /> fZ, <br /> APPIICAM BJ$h14F.SSfAQ9NCT, <br /> S;-F <br /> on"; , SE0--,*j0 <br /> 4EONFI Tre- 4�1r_ - 98�L.- <br /> --POy 5 <br /> TFNTAT1VE-Aj>pojK�KNT0ATF!— <br /> P(MECK SOX To F;XPEI)ITE PAQUEST-03 Et-REQU EssablN BUSINESISDATS <br /> DATE <br /> SIGNATURE Of APPLICANT <br /> 14rr <br /> FILE ADDRESS <br /> fz-007 I :-01 ST U fti <br /> o <br /> -7C� nit 2 <br /> L> UnIt3 <br /> 0 UnR4 <br /> -gly <br /> it. <br /> CNVIRC)NMENTAL 14EALTH DEPARTMENT FILES v�o <br /> ARA-MbAFNT 0 souD WASTE r <br /> uNorAGROUND TANK(LIST)CLVkNUP SITE(Lop) 0 IHOUS'NC rn DoUr)WASTE VEHICLE <br /> ge,oTgra CLEMUP SITE(NON-LOP) 0 FOOD FAPIIJTY C3 DA�RY <br /> ojRr_mOvAL) 13 0<)o K9NNFL M PKG TREATMI�NT PLANT <br /> �1 (:�HleKEN RANCH <br /> U F1111 UN m FujmPER TmjCKrYAItDFcHrm TOiLM <br /> K m M=LmOTEL (3 LAND USE APPLICATION 81TES <br /> 13 T1EqDDPVURSmv Ci pacuSPA <br /> in TATrovIGODY I"IERCiNG C3 OTHER(PLIF-ABESPECe' <br /> mr;DIC�WAX�FACILITY )01 f1j"fMM the Ilat AbOye by rbacking <br /> List tip to ton addrors"in the space above. Select the el c 209 4 r rnnfl to <br /> fi=94 <br /> n. The MOO <br /> 2. duled <br /> "low. A now <br /> 3. the wwanso <br /> prior to review. <br /> 4. of th a Pli FU rs file eyiawsbytheslmo a I <br /> ant dates rnust b4?confirrn9d with EHO st8"- <br /> *TENT a oi in be prOC95sed the noxt business'day. r--IPF <br /> ApplicatiOns ce e4 2"'or 3:00 PM W <br /> TIME <br /> CONFIRMED ApPOINTMENT DATE <br /> PHONE FAX INITIALS <br /> I'M "T"'F <br /> D _C 'ME <br /> ATE CONFIRMED REVIEW DATF <br /> `TF <br /> RVIEMO YFS NO <br /> ----------- <br />