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12/31/2803 09:30 7077483171 CERES ASSOCIATE 11 , may ,j PAGE u01/e <br /> i _ Em)LDG KUMBER <br /> ltxT�-t2CCEJVEE+-,. <br /> l; _;:SAN JOAQUIN COUNTYPUBLiC HEALTH SERVICES <br /> ENVIRONMENTAL- HEALTH DIVISION { <br /> D E G 3 J. 2003 <br /> 304 EAST <br /> STC)CKT N GA 95202 !7 FLOOR <br /> (209) 488-3426 <br /> P :1BLiC RECORDS. RELEASE APPLICATION <br /> BUSINI=SS/AG<NICY C'[.+tf�j�C..D C I A/ <br /> I1PPLICANT•� cyr) <br /> gDORM ' <br /> 7 Its t Is FACSIMILE 4 � <br /> TENTATIVE"APPOINTMENT DATETIME <br /> (Please give 7 to 10 business days from data ofLot <br /> tl application su�mfttal) * S Gi't� <br /> 1 � <br /> - UEST PROCESSED IN 3 BUSIktESS DAYS <br /> T !2E t1EST-$7 .n FE=E A <br /> oX T4 E.XPEDI E Q <br /> CHECK B J� <br /> SIGNATURE OF APPLICANT DATE <br /> TH[3 SIDE EHL}ST'AF 1151=ONLY f <br /> l PILE ADDRESS pROGFihlSll ELEMENTS SEARCH y <br /> 1 <br /> OIC- _ <br /> s <br /> 1 <br /> i <br /> I <br /> 1 <br /> i <br /> i <br /> EI'iVIRONMF-N-fAL HEALTH DIVISION FILES <br /> ! <br /> CI 6OLID WASTE FACILITY{ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 H6U51NG AESATi"MENT 0 SOLID WASTI=VEHTCLIE: L� <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAGEL1T1r rr <br /> UNDERGRO$JND TANk(IVI6wrORINOIREMOVAL) CJ MG KENNEL ❑ DATKY 1� <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZgRQOus WASTE G�NERPTbFt ❑ moTEL HOTEL Co pUMPEFt TRUCKIYAROICK15 I TOILET <br /> jnERED PERMrr7ED FACILITY ❑ FOOLISPA 0 LANG}USE APPLICATION SrrES <br /> TATTbaIHODY PE MCING 0 pURLtC WATER SYSTEM �OTKER{PLEASE SPECIF=Y ABOVer✓ <br /> MEDICAL WASTE FACILITY <br /> List up to Cert addresses in the space above. Select the types)of files from the list alcove by cl,ecki <br /> the appropriate box(es). At least one fie type MUSS be selected. Fax to (2091 464-0'i 19 ar mail to th <br /> address .n i ed above. <br /> EHD will notify tho 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 fill , <br /> will be held for a maximum of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> A file that is actively using worked on by EHL]Staff may not be irl�rrlediBltely available for review. A t r <br /> application may be submitter!When the file is available. EHD staff at the ex ei <br /> Any file not returned in the same condition as released will be reorganized by 8 4r. <br /> ! of the applicant. Future file reviews by the same applicant may require a $78.00 deposit rior to rev <br /> *TENTATIVE appointment dates must be confirmed With EN staff. P <br /> 6. Applications reCeived after 3:00 pm will-be processed the next business day. <br /> ONFIRMED APPOINTMENT DATE TIME <br /> ATE CONFIRMED PHONE FAX IM1T1Al-FAX _ -- <br /> EVIEWED YES NOREVIEW DATE �- <br /> 0o sa O?I;araa TOTAL P <br />