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c +9168520307 T-017 P.01/02 F-227 <br /> ,�I <br /> Aus-09-04 21:43 From-TTI TETRA TECH <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> D° DCDBMDD ENVIRONMENTAL HEALTH I)EPARTME T <br /> 304 E Wcbzr Ave 3r1 Floor Stockton,CA 9520 <br /> AUG 10 2004(209)368-3420 Fax: (209)464-0135 Web. www.co.Sanjoaqu' ca.us(ehd i4b <br /> ENV nuiWENT HEALTH PUBLIC RECORDS RELEASE APPLICA ION <br /> PE -r 1 r f GH GMT <br /> gPPL1CANT� `�>=�`�at' � 1"' �a�� BUSINESSIAGENCY- tE T� <br /> Y'1 . 7$ 1 NChIOG Gt''RV <br /> - <br /> ADDRESS: 1 <br /> PHONE: I - 8 53- 54 FACSIMILE: ( $15 <br /> z- <br /> TENTATIVE"APPOINTMENT DATE: /r'w _= Time: <br /> �ry (Please allow 19 ausiness days from data of appikaGcn SwOrm aI) <br /> D CRECK 6OX TO EXPEDITE RFQUFST-$93.Q0 FEE—REQUEST PROLES DIN 3 B INESS p YS <br /> SIGNATURE OF APPLICANT DATE <br /> Deparu l use only <br /> Fla ADDRESS UNIT <br /> [..IE. C 6Tb G G [] unit 1 <br /> 2. mN' � S fit} ro. C A P I <br /> s su,a 3 C q Unit <br /> ♦ Svwt 3 1• G <br /> s. sued, 4a5 �Unit3 <br /> 5p).lh� g sem i tr T G 6 <br /> i 1 r. suw, 2 S7ls/L. - C• Unit 4 <br /> s.w a <br /> MD GFA ALVD. c. M G p5 <br /> i~ !D� S� C.E <br /> Ipt <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING A)3ATEMENT ASO D WASTE FACILITY <br /> OTHER CLEANUP SITE INON-LOP) Q FOOD FACILITY G SO D WASTE VEHICLE <br /> UNDER GROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL ❑ DA Y <br /> HAZARDOUS WASTE GENERATOR Q CRIGKFN RANCH (7 PK TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY Q MOTELIHOTFL ❑ Pu PER TRUCK!'(ARD/CMEM TOILETS <br /> t7 TAT-FOO1500Y PIFRCING ❑ POOLISPA Q p USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files om the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax t 2091464-0138 or mail to the <br /> add==ed above. <br /> 2. EHP will notify the applicant if any EHD files exist. An appointment for ev)aw will be confirmed <br /> approximately five business days but no later than ten(10)days after r eipt of application. The files <br /> will be hold for A maximum of five business days for review- Appointm nts should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHP staff may not be immedia ely 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 reorgani by FHD staff at the expense <br /> of the applicant. Future file reviews by the Same applicant may require $93.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 100 pm will be processed the next busines day. <br /> CONFIRMFQ APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE ` <br /> t:no waz-0ua . <br /> awmc� <br /> i <br />