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Mar•10. 2003 4:49PM CONn"I EARTH TECHNOLOGIES <br />Ni) -3039 P• 1/1 <br />RATE-fl)'��'J�i= I•�I Jr <br />�II AN JOAQUIN COUNTYPUBLIC HEALTH SERVICES Q1A00NuaWM <br />ENVIRONMENTAL HEALTH DIVISiON <br />MAR 1'0 2003 304 EAST WESER AVENUE, THIRD FLOOR <br />Si•OCKTON CA 95202 <br />--if-WENT HEALTH (209) 468-3420 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT SUSINESS/AGENCY <br />ADDRESS ��� ' • _ <br />PHONE .� w„- -- _ _ F'ACSA411t.F.� r __ <br />TENTATIVE* APPOINTMENT DAzF- 4 Iii zrc.� 0 3 TIME$— D 3 <br />(Pt$"* give y to 40 business days from date of application subrnittal) <br />'—+ CHECK BOX TO EXPEDiM REQUEST -S87.00 FEE – R>~UUEST PROCIESsE0 IN 3 BUSINESS DAY <br />e:�.U <br />SIGNATURE OF APPLICANT DATE _ JO G <br />12 *A ZJ =iZS. • •. y • <br />r a � <br />V F. a ►moi <br />_VIP <br />_s <br />P <br />SO <br />UNDERGROUND TANK (UST) CLEANUP SITi~ Q -OP) CI HOUSING ABATEMENT SOLD WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY 9 SOLID WASTE VE?1ICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAiRY <br />HAZARDOUS WASTE GENERATOR 0 • CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCtrJ ARDICHEIA TOILETS <br />0 TATTOO(SODY PMCING 0 P600SPA '- - ❑ LAND USE APPLICATION SITES <br />Q MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 0 0 -MER (PLEAS-Ri SPECIFY A40VE) <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 to L2,09) 464_•013$ or mailto the <br />address indlcated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review witI be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The iilas <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 new <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 EHO 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 EIit7 staff, <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME _ <br />