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v 12/28/2003 18:38 92520?n1 AEI CONSULTANTS-r) PAGE 01 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JJOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPARTMENT <br /> 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> DE C 31 IW) 468-3420 Fax: (209)464-0138 WA: wvm.co.san-joaquirLca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Yl ` BUSINESSfAGENCY: <br /> ADDRESS: rr�IGG\ �(�� �J�,1�-Rp'D�.� <br /> Olt <br /> Ip� e,�,�r <br /> PHONE:�"I Y.1 J /mil:j l.4'lMJ e� 15 <br /> FA-C�SIIMILE: <br /> -TENTATIVE*APPOINTMENT DATE: �YAn (2Time: <br /> (Please allow 10 business days from dale of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST <br /> -$93.00 FIE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l l { 1�- DATE 3D c <br /> Department Use Only <br /> i <br /> UNIT <br /> FILE ADDRESS <br /> WE Sor, A o ❑ Unit 1 <br /> 1,11 11.11 <br /> \, it Unit2 /] <br /> n 1 <br /> �) 5. street U0. Gr Uflit 3 <br /> \V.r e. &reef i 1 .�a�w',SG <br /> 1..1 r. s .e« 1(l'I Wfs G _ Unit 4 _ <br /> „ <br /> B. sox 2 1 n Gt <br /> Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDSOLID WASTE FACILITY <br /> M OTHER CLEANUP <br /> TANK(UST)CLEANUP SUE(LOP) ❑ HOODING ABATEMENT 11 SOLID WASTE VEHICLE <br /> ffi OTHER CLEANUP SITE(NONd.OP) ❑ FOOD FACILrr'r <br /> M UNDERGROUND TANK(MONITORING(REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> > HAZaRpOUS WASTE GENERATOR ❑ CHICKEN RANCH i� PKG TREATMENT PLANT <br /> SI TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> d TIERED PERMITTED <br /> SODY PIERCING 0 POOUSPA � LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY E3 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 checkl% <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the ali <br /> ppcant 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. Ane <br /> application may be submitted when the file is available. EHD staff at the expens <br /> 4. Any file not returned in the same condition as released will be reorganized by <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie <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 <br /> TIME <br /> DATNpIRMED "PHONE <br /> FAX' INITIALS <br /> I° CO ' <br /> REVIEW D <br /> REVIEWED YES NO ATE <br /> ' enp ascz-0ae - <br />