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06/22/2004 11: 59 303769 TECHLAW INC PAGE 02/0 <br /> EHD LOG NUMBER <br /> oATESElylp-,� SAN JOAQUIN COUNTY <br /> I�� � ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 2 2004 304 E Weber Ave 3 T Floor Stockton,CA 95205 <br /> (209)469-3420 Fax: (209)464-0138 Web: www.co.9an joaquin.ca.us/ehd <br /> ENVIRONMENT REALM <br /> PERMIT/SERVICES PUBLIC RECORpS RELEASE-TAPPLICATION <br /> APPLICANT: <br /> ._ IUSIINESWAGENCY: <br /> ADDRESS: 5I1 <br /> 2 <br /> e4Q.I 2,17 (aalclgjn r o 15 D L'l c7_L_._. <br /> .tet p U I,,�'7�\ �' �n 2i `o�q <br /> PHONE:��d�'i��(n'�"I�"I FACSIMILE:� J 4 <br /> TENTATIVE"APPOINTMENT OATS: <br /> (Pleosa allow 10 business days from date of application 9ubmlttel) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 PEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I flD 1 � DATE _ (0 IZ <br /> Departmerd Use ONY <br /> FILE ADDRESS UNIT <br /> AMC <br /> A"q,o,UJ �,_ja U G Cal Unit 1 <br /> z. svice �i35 5 . LI a ✓' 3���� <br /> a so-aei19 SD f. Si -F. Unit2 l <br /> U c � <br /> s�a.. ss5s�wmI 3foo SS.• Lin , pnd <br /> C <br /> s. Li nt <br /> I C' <br /> D <br /> s, suealqFQQ Alr <br /> to. suer a "v.• <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ````,, L ZQO� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT � SOLID WASTE FACILITY0- ' <br /> X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONIT'ORING7REMOVAL) 0 OOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> • TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCKrYAROICHEM TOILETS <br /> ❑ TATTOOBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 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(2091415"138 or mail_o 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 /> will be held for a maximum oe business f five businays but no ess dayser afor ten (110) <br /> Appointments shouls after receipt of application, <br /> Ibe scheduled files <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 appllcanL 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 FAX INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> euro�a.aaaoa <br /> arumm <br />