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09/16/2003 15:53 925371 015 GEOCON - EAST oA.• PAGE 01/1 <br /> ENVIRDNMENT*_ALTH PAGE 02 <br /> DATE REOEtVEO • cnr+���••_-..__ <br /> SAN JOA.QUIN COUNTY <br /> o � it c <br /> ENVIRONMENTAL REAT.'THDEPARTMENT <br /> 304 T Weber Ave 3'c Floor Stock Olt, CA 95205 fJ� <br /> SEP 1 6 2001209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caus/ehd 14 q <br /> 11WROtMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> D t - BUSINE96/AGENCY; 0� Co G <br /> APPLICANT; 2 R <br /> ADDRESS: 3 Allo <br /> / /_G� <br /> PHONE:r/ Z S` �7— `� ( �� FACSIMILH: Z S` 3 Ze` <br /> TENTATIVE`APPOINTMENT DATE_ Time; <br /> (Please allow 10 t)ueineAs days from dste of 3pp114*800 submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE–REQU PROCESS 01 U NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Nout'hant Use Only <br /> UNIT <br /> ILE ADDRESS " <br /> s 3 O y} Unit 1 <br /> C <br /> ,r d O c L Un 2 <br /> a s i O O �/ C <br /> s. !a c, U pni't <br /> e C ` <br /> 7 Air 1 07 <br /> z eoly <br /> a <br /> to. Site <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> • UNDERGROUND TANK( 13 SOLID WASTE FACILITY <br /> CLEANUP SITE(LOP) O HOUSING ABATEMENT <br /> O OTHER CLEANUP STM(NONNON-LOP) ❑ pOOD FACILITY SOLID WASTE VEHICLELrtY 0 DAIRY <br /> C] UNDERGROUND TANK(MOM7oRINCJREMOVAL) ❑ DOG KENNEL O PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GEN)?RATOR ❑ CHICKEN RANCH - 0 pLWpER TRUCKIYARDICHEM TOUTS <br /> ❑ TIERED PERMITTED FACILITY 0 MOTBL(HOTBL 0 LAND USE APPLICATION SMS <br /> C1 TATTOOIBODY PIERCING O POOVSPA - <br /> O MEOICAL WASTE FACILITY O OTHER(PLIAS[SPECIFIC <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list abo^e by checking. <br /> the appropriate box(es), At least one file type MUST be selected. Fax to a -- <br /> tILe <br /> ajL drew indicated a ov . <br /> 2. EHD 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 be scheduled <br /> accordingly. . <br /> 3. Mile that is actively being worked an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is avaitable. <br /> 4. Any tie not returned in the same condition as released will be reorganized by EMP staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revlaw• <br /> S. '''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 /> CONFIRMED APPOINTMENT DATE ' TIME <br /> DATE CONFIRMED PHONE FAX' INMAL5 <br /> REVIEWED YES NO REVIEW DATE, <br /> j <br />