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06/22/2004 11:59 30376399 TECHLAW INC • PAGE 02/0 <br /> a� - <br /> EHD LOG NUMBER <br /> DATRIAPEI SAN JOAQuzN COUNTY <br /> ENVIRONMENTAL HEALTFI DEpAItTMFNT <br /> JUN 2 2 2004 304 E Weber Ave 3 T Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> ENVIRONMIHJ hLNL-1H <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANY: A G I1�nl C�'� BUSINESS(AGENCY: <br /> ADDRESS: <br /> 51,2 <br /> PHONE: <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE:_VI GIV't' I Z -TIm' <br /> (please allow 10 business days trom date Of application submitiel) <br /> 13 CHECK BOX TO EXPEDITE REQUESTpe$-93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT 1�5 ' (DIZ2-T- �- <br /> - DeparlmeM Use Only <br /> FILE ADDRESS r v�J - UNIT <br /> �.- I � <br /> CAY <br /> Unit 1 <br /> 5D Si �• �Unit2 �.3� � 1 <br /> 3 bPBel �� <br /> a. sxxt 0 0 ., c <br /> s. seee� <br /> :7'Lo S• '11- In D / Unit <br /> i. sv9,e 3 g. Li cn +' Unit4 <br /> a 9� � D <br /> s, saaei DD <br /> U <br /> 10. SVeat <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES Z � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSINGABATEMENT Q SOLID WASTE FACILITY UDWASTE �\``v\ ' <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> UNDERGROUND TANK(MONrroRINGIREMOVAL) CI DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ PUMPER TRUCx/YARPICHEM TOILETS <br /> 0 TIERED PERMITTED FACILITY E3MOTELIHOTEL <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPEGIFYI <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 W(2091464-0138 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 /> approximately five business days but no later than ten (10)daysafter MCOlpt Of <br /> should pibe eche- Thefiles <br /> will be held for a maximum of five business days for review. App <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$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWEq YES NO REVIEW DATE <br /> eHo�a-w.uee <br /> aramm <br />