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06/22/2004 11:59 303763--99 <br />TECHLAW INC PAGE 02/0 <br />v EHD LOG NUMBER <br />CAT frEl SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALT14 DEPARTMENT <br />JUN 2 2 2004 304 E Weber Ave 3.d Floor Stockton, CA 95205 <br />(209) 468-3420 Fax: (209) 464-0138 Web: vrvw.co.san-joaquin.ca,us/ebd <br />10 <br />ENVIRONMiUdT hLAL) H <br />PERMIT/SERVICES PU13LIC RECORDS RELEASE APPLICATION <br />APPLICANT:_ 11A1 nn(i'1�t_t/I, BUSINESSIAGENCY: _aad aw <br />ADDRESS: <br />fdld�vgi,t4.�P• 12(x\ (aol nvp�O gS�DN(7_L_. <br />PHONE; FACSIMILE: <br />�D�iI (O' �� 1 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: <br />(Please allow 10 business days from date of application 9ubmltt8l) <br />13 CHECK BOX TO EXPEDITE REQUEST - $9100 FEE -REQUEST PROCESSED IN 1 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE _ (0 I- O <br />Department Use Only <br />A.b- Cg1builct <br />❑ Unit 1 <br />Unit 2 <br />Unit 4 <br />1a � <br />a <br />b <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES ,2 JQpk <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILIT1!0\� <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY M SOLID WASTE VEHICLE <br />j� UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL E3 DAIRY <br />�( HAZARDOUS WASTE GENERATOR M CHICKEN RANCH 0 PKG TREATMENT PLANT <br />C3 TIERED PERMITTED FACILITY O MOTELMOIEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTOOIBODY PIERCING D POOL/SPA 0 LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the types) of files from the list 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 above. <br />2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br />approximately five business days but no later than ten (1o) 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 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 EHD staff at the expense <br />of the applicant Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />S. 'TENTATIVE appointment dates must be Confirmed with EHD staff. <br />6. Applications received after 8:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES <br />TIME <br />PHONE FAX INITIALS <br />NO REVIEW DATE <br />