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AUG-23-2004 15:51 C17 -')R EARTH TECH 209 532 0773 P.01/& <br /> DATE RECEIVED. .` EHD LOG NUI R <br /> G1E� � '+ SAN JOAQUEN COUNTY <br /> ENVMONMEnAL REA.LTH DUARTMENT <br /> AVG 3 2004 304 E WeberAve 3'd Floor StoclloT, CA 95205 <br /> �2�? 468-3420 Fax: (209) 4640138 Web, w .co.snoaqica_us/ehdqb07 <br /> v ��ZSER� s <br /> M PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,PA-MW BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONJ� l FACSIMJLE � 173 <br /> TENTATIVE*APPorNT6AENr Dare 12tW4 Time, <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RE UEST-$93.00 -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 . 6 <br /> Denattfnent Use Oniv <br /> FILE ADDRESS UNIT <br /> �XD AJ r15 t ON.Cr' p Unit 1 <br /> Z <br /> 3. slr� Od L pmbo Cky , 5 � Unit2 <br /> ,. s K W6ST G ZCk-F_ <br /> ��✓ s. sz'.et 6 I Unit 3 <br /> so.ei a t <br /> f 7. Sft MyU h7 c Unit 4 <br /> Unit 5 <br /> 19ENVIRONMENTAL HEALTH DEP h4vFILE\_1 � U n <br /> UNDERGROUND TANK(UST)CLEANUP srre(Lop) 0 HOUSING ABATEMENT (' SOLID WASE FACILITY <br /> OTHER CL9ANUP SITE(NON-LOP) — U FOOD FACILITY 1r SOLID WASTE VEHICLE <br /> UNDERGROUND TANK[MONITORING(REMOVAL) 0 DOG KENNEL d DAJRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FAMITY ❑ MOTELIHOTEL El PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING CI POOLISPA P!r LAND USE APPLICATION SITES <br /> t7 MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checkin <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. EHD will notify the applicant if any EHO 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. A file that is actively being worked on 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 returned in the same condition as released will be reorganized by EHD staff at the expens <br /> of the applicant. Puture file 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 next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NOREVIEW DAT1 <br /> q-3-C,(4 - 1 Oocado U T� �Z E(d [-0 +'nn A. TOTAL P.O: <br />