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N o• 4 9 2 9 L`P • 2 `"`'M"` <br />Apr •21. 2004 1 05PM Ne ASdAeNrs JOAQUIN Assoc. <br />V MATE Kt=�,c,vcv <br />ENVIRONMENTAL SALT® D nPARTM 05 T <br />CA 304 E Weber Ave 3rd Floor S <br />464-0138 <br />R 0 <br />Web: www.co.san joaquin.ca.us/ehd <br />(2092068-3420 Fax: (209 ) <br />AP2 vyTTtj .TC RECORDS PELEASE APPLICATION <br />APPLICANT: J <br />t, O BUSINESSIAGENCY: <br />ADDRESS: <br />^ <br />PHONE: 3tUa - 3 FACSIMILE: s <br />t <br />Time: <br />TENTATIVE* APPOINTMENT DATE: <br />(Please allow 10 business days from date of application submittal) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE —REQUEST PROCESSED IN 3 BUSINESS DAYSDATE <br />SIGNATURE OF APPLICANT <br />Department Use Only <br />UNIT <br />® Unit i <br />p Unit 2 <br />Unit 3 <br />Unit 4 <br />Unit 5 <br />ENVIRONMENTAL HEALTH DGt'Atc 1 mL1141 / <br />O HOUSING ABATEMENT O SOLID WASTE FACILITY <br />❑ FOOD FACILITY O SOLID WASTE VEHICLE <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) DAIRY <br />�) OTHER CLEANUP SITE (NON -LOP) p ❑ DOG KENNEL ❑ DAIRY <br />TREATMENT PLANT <br />UNDERGROUND TANK (MONITORINGlREMOVAL) d CHICKEN RANCH ❑ PUMPER TRUCKIYARDICHEM TO <br />HAZARDOUS WASTE GENERATOR O MOTELIHOTEL O LAND USE APPLICATION SITES <br />TIERED PERMITTED FACILITY O POOLISPA — <br />a TATTOOIBODY PIERCING O OTHER (PLEASE SPECIFY) <br />O MEDICAL WASTE FACILITY <br />ace above. Select the We(s) of files from the list above by checkil <br />q List up to ten addresses in the space MUST be selected. Fax to 209 464-0 t38 or mail to th <br />the appropriate boic(es). At least one file type <br />address indicated above. ointment for review wt11 be confirmed <br />EHD will notify the applicant if any EHD files exist. An apo in s after receipt of application. The file: <br />2. s but no tater than ten ( ) Y <br />approximately five business day ointments should be scheduled <br />will be held for a maximum of five business days for review. App <br />accordingly.EHD staff may not be immediately available for review. A r = <br />3, A file that is actively being worked on by <br />application may be submitted when the file is available. prior to rev <br />4. Any file not returned in the same condition tesame applicant t may require a $93.0.0 be reorganized by Hdeposs P the expel <br />of the applicant. Future file reviews by <br />5 *TENTATIVE appointment dates must be confirmed with EHD staff. <br />rDATE <br />Applications received after 3:00 pm will be processed the next business day. <br />TIME <br />RMED APPOINTMENT DATE INITIALS <br />PHONE FAX <br />ONFIRMED REVIEW DATE <br />ED <br />YES NO <br />SIM003 <br />