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06/16/04 WED 08:49 FAX 916 366 7013 KLEINFELDER <br /> DATE RECEIVED SAN JOAQUIN COUNTY ...._., <br /> 541 ! <br /> ENVIRONMENTAL HEALTH DEPARTMENT304 E Weber Ave and Floor Stockton,CA 95205 <br /> 04(209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquirLcaus1ehd I <br /> ENVI OONNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PLHM11/6RVIC S ((l� <br /> APPLICANT:_ 3enn �f.0 f` c-nrP_ BUSINESSIAGENCY:�PinPdJ('ri 14r . <br /> ADDRESS: 3077 FItF_ Ci.rc� Sa�.rnamt.r,�n C'J4 <br /> PHONE: (9&S)3(0(n— 1701 F//A��CSIMBE: M/(P) 3I46 -7013 <br /> TENTATIVE'APPOINTMENT DATE:t17 l,bl l r PCI r'I PS+ CW riL°ll> W: <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST QUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , l= 44=' DATE CPI(p/04 <br /> Department Use Only <br /> FILE ADDRESS WI <br /> 11177 2 — ❑ Unit 1 <br /> 2. seed — <br /> ' a..,0. <br /> ❑ Unit 2 <br /> x stree, Unit 3 <br /> c sew <br /> r. str.a Unit 4 <br /> 0. Street @ <br /> e. strw W ❑ Unit 5 <br /> ,o. sew LA'I07 k e. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ® UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 6 HOUSING ABATEMENT IN SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IN UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOC KENNEL ® DAIRY <br /> 63 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOBODY PIERCING - ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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(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 (10)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 /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED '. ,PHONE FAX-- <br /> REVIEWED <br /> AX'REVIEWED +- YES NO REVIEW DATE <br /> ero soe <br /> sm2sas <br />