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06/22/2004 11:59 303763 3 TECHLAW INC PAGE 02/0 <br /> EHD LOG NUMBER <br /> DAT Iv c�� SAN JOAQUIN COUNTY <br /> (l l ENVIRONMENTAL HFALTIx.DFpARTlYZENT <br /> JUN 2 2 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209)466-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca,us/ehd <br /> ENVIRONMIENT hLNDr <br /> PERMIT/SERVICES PUB <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSSI'AGENCY: <br /> ADDRESS: � l-i <br /> PHONE:,—��D�� "1 f FACSIMILE <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 PAYS <br /> !� L <br /> SIGNATURE OF APPLICANT _� - �� DATE De1.0 <br /> DATE <br /> Use only <br /> ``� ` <br /> FILE ADDRESS UN1T <br /> ,�tl(�J��{,U�,Uta �, street � �- ❑ Unit 1 <br /> S . ✓ -�`1 <br /> z street X535 Li �„ �Unit2 <br /> eet 3' <br /> 3 str77 i <br /> 4. s+en 0 C G�/' <br /> io 5. L41 G Unit <br /> 5. SUeet <br /> 6, street o �� C <br /> 9. Li cn ✓ Unit 4 <br /> 7. street N � <br /> s sweat <br /> 6, street <br /> 00 ✓ <br /> to, street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES —2. 2zzk <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP)MFOOD fl NG ABATEMENT Q SOLID WASTE VEHICLE P� <br /> OTHER CLEANUP SITE <br /> ON-LOP) ILITY 0 DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> MOTE�O�L ❑ PUMPER TRUCKlYAROlCHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY oPOOUSPA M LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ <br /> OTHER(PLEASE SPECIFY) <br /> * MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the types) of files from the fist above by checking <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 gbove. y ointment far review will be confirmed <br /> 2. EHD will notify the applicant if an EHD files exist, An appointment <br /> after receipt of application. The files <br /> approximately five business days but no later than ten (10) y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. erase <br /> 4. Any file not returned in the same condition as released will be reorgalnIza �by�EHD <br /> staff <br /> ffit pri r to review. <br /> of the applicant. Future file reviews by the same applicant may req <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 <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> �Hn�a.va.aoa <br /> arazoos <br />