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\ 10/30/2002 08:20 9252836121 AEI CONSULTANTS (SF) PAGE 02 <br />J 10/28/2002 11:26 4640138 ENVIRONMENTAL HEA PACE 03 <br />r- ti Elm %,M tAAN)CR <br />' SAN JOAQ NT C HEALTH SERVICES WWI � <br />ENVIRONMENTAL <br />ENTALAL HEALTH <br />EALTH DIVISION1 <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209)468.3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT r'-1�•� riY�CG�Cti- �4 BUSINESS/AGENCY <br />A A _6 Ut1Jcl <br />ADDRESS 121,lkv v .G <br />'•� Q��i� FAerIIa1LE - <br />PHONE wF <br />TENTATIVE'.APPOINTMENTDATEI ,_5 TIME <br />tPlcaso give T to io busing" days 1 m date of apPlfaatWn supmltlaq <br />❑ CHECK BOX TO t7(PEDYCE REQUEST-i67•�' Et s� DAYS <br />—` DATE SCi l <br />ctr•_un'r11RF OF APPLICANT <br />ENVIRONMENTAL, HEALTH DIVISION FILES <br />O <br />N <br />0 <br />+1 <br />J <br />O SOLIDWASTEFACILITY <br />a�e�,� UNOERGROUNO TANK (UST) CLEANUP SITE tLOPj 0 HOUSING <br />0 FOOD FACILITY ABATEMENT ❑ SOLID WASTE VEHICLE <br />❑ OTHER CLEANUP, SITE (NON -LOP) p DOG KENNEL 0 DAIRY <br />PNUNOGRGROUNp TANK (MONnDRINGIREMOVAL) 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR ❑ PUMPER TRUCWYAROICHEM TOILETS <br />O TIEMO PERMnTMo FACILITY O POOLISPA O LAND USE APPLICATION SMS <br />❑ TATTOOl80DY PFJRCING ❑ PUBJJC WATER SYSTEM ❑ OTHER (PLEASE sPEC1Ff ABOVE) <br />❑ MEDICAL WASTE FACILITY <br />_last up to fon addresses in the space above- Solect the types) of tilos from the list above by checking <br />1. <br />file type MUST be selected. Fax to (2091464-0139 or man tot e <br />the appropriate box(es). At least one <br />address indl=lqd above. . <br />2 EHD wit; notify the applicant if any EHD filos exist. An appointment for review will be Confirmed <br />approximately five business days but no later than <br />ton <br />days <br />Appointments should schedu ed teles <br />will be hold for a maximum of rive business days forreview. <br />accordingly. <br />3- 1 A file that,is actively bDing worked on by EHD Staff may not be Immediately available for re,riew. naw <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 $89.00 deposit prior 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 />CONFIRMED APPOINTMENT DATE. TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />