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06/16/04 WED 08:49 FAX 9167013 KLEINFELDER - ,, .�00 <br /> DATE RECEIVED SAN JOAQUIN COUNTY • V <br /> D �(� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> JUN 1 <br /> 04(21)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caus/chd <br /> ENPViRONMEN - PUBLIC <br /> BLIC RECORDS RELEASE� <br /> APPLICATION <br /> MT/SRVICES ((1� U/ <br /> APPLICANT: PYy)Qf f — Y-P- BUSINESSIAGExcY: )Ln QAJer I <br /> nc . <br /> ADDRESS:: 3(Dw IRA-e- it k¢ i <br /> PHONE: o)Na o- <br /> 1701 FACSIMILE: L9I�o� 1)Itz Ca_ _7()j3 - <br /> TENTATIVE`APPOINTMENT DATE:Al UO1 A r n r I I P ST CnnVPIxgme: <br /> (Please allow 10 buslness days from date of application submittal) <br /> CHECK BOAC TO EXPEDITE REQUEST-$93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / ^ DATE 6011(010q <br /> Department Use Only <br /> FILE ADDRESS Uiii1 <br /> t 77 lane a - ❑ Unit 1 <br /> 2. 5hee1 - ntDCYiDA 1 <br /> a so-ed 2 [I Unit 2 �T <br /> 4. 9aM �� <br /> s. Seed Unit 3 0.0.0.-"✓/ <br /> 6. Syed <br /> r. sued Unit 4 <br /> 6. co-edr7n . <br /> s. seed W ❑ Unit 5 <br /> 16. Shed 401 E> 7 T <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IM UNDERGROUND TANK(UST)CLEANUP SITE(LOP) B HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> U UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ® DAIRY <br /> (a HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARD/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)464-0738 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$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED :PHONE : FW. IN1iU1LS <br /> REVIEWED ,- YES NO REVIEW DATE <br /> MD rwxaoa . <br /> 6$aam <br />