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11/05/2004 16:20 925283111111111111111111AEI CONSULTANTS (SP) PAGE 02 <br /> 16111111111111111 EHD LOG NUMBEI <br /> 4h II�LSDD <br /> ENTSAN JOAQUINCOUNTY <br /> ONMENTAL HEALTH DEPARTMENT <br /> 55g,}2g0b0g4 q 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> 0" vi41 N Y HEKC�H2O OFax: (209)464-0138 Web:www.co.san joaquiu taus/ehd <br /> f L;-,, T/SERVICEWBLIC RECORDS RELEASE APPLICATIION ZI t�7 <br /> APPLICANT: LtAA `Jn,n 5601 BUSINESSfAGENCY: C J4Sl/�0.(ll S <br /> ADDRESS; LV Wink OW^ 5"1I <br /> PHONE: r• M t9wo -FACSIMILE: qas PL3 �.t <br /> TENTATIVE"AP OINTMENT DATE: 1� 1� O Time: �N1 <br /> ase allow 10 business days from date of application submiffAl) <br /> CH K BOX T • �' QUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS 'p� CG <br /> SIGU f01 CANT DATE ' 1 Dt I <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> St a + ❑ Unit 1 <br /> V 11 3. 9Veel t`ll.SlerfO- � 1_. Y d I+ <br /> 4, saea, — 5 YYQ city <br /> t ❑ <br /> Unit 2 <br /> 5. SUtN 1 G' Wowt� <br /> e. svee+ 4 S w1J1 Yl a i Unit 3 <br /> II + ZLEE ; <br /> + It <br /> t-. .. 1.. ? e7unit 4 <br /> ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH Or <br /> ,. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABAT �SOLID WASTE FACILITY <br /> Pr OTHER CLEANUP SITE(NON-AP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Ja' UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> ❑ TATTOOlBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY C7 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. Afile 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 de p rior to review <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 /> .. _.:.,4 <br /> CONFIRMED APPOINTMENT DATE7. <br /> DATECONFIRMED PHONE -FAX" INITIALS s <br /> REVIEWED YES NO REVIEW DATE <br /> EHD�a 20 W - <br /> arerzaas <br />